Preadministration of flurbiprofen suppresses prostaglandin production and postoperative pain in orthopedic patients undergoing tourniquet inflation

被引:121
作者
Takada, Masafumi [1 ]
Fukusaki, Makoto
Terao, Yoshiaki
Yamashita, Kazunori
Inadomi, Chiaki
Takada, Miwako
Sumikawa, Koji
机构
[1] Nagasaki Rosai Hosp, Dept Anesthesia, Sasebo 8570134, Japan
[2] Nagasaki Univ, Sch Med, Dept Anesthesiol, Nagasaki 8528501, Japan
关键词
equipment and supplies; tourniquet; anti-inflammatory agents; antirheumatic agents; inflammation mediators; eicosanoids; dinoprostone (prostaglandin E2); pathological conditions; signs and symptoms; pain; postoperative;
D O I
10.1016/j.jclinane.2006.05.028
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Study Objectives: To evaluate the effect of preadministration of flurbiprofen on the plasma concentrations of prostaglandin E2 (PGE2) and postoperative pain. Design: Prospective, randomized, controlled and double-blind study. Setting: Inpatient surgery at Nagasaki Rosai Hospital. Patients: 32 ASA physical status I to II patients scheduled for total knee arthroplasty or open anterior cruciate ligament reconstruction. Interventions: Patients were randomly assigned to two groups. Five minutes before tourniquet inflation (350 mmHg), group A (n = 16) received placebo (intralipid, one mL . kg(-1)), and group B (n = 16) received flurbiprofen one mg . kg(-1) IV Catheters were placed in the ipsilateral femoral vein for collection of local blood and in a cubital vein for sampling of systemic blood. Measurements: Prostaglandin E2 (femoral vein and cubital vein) was measured before tourniquet inflation (T1), before tourniquet deflation (T2), and immediately after tourniquet deflation (T3). Postoperative analgesia was provided with intravenous buprenorphine, 0.1 mg, on patient demand. Pain (Visual Analog Scale) was assessed at 0.5, one, two, 4, 6, 12 and 24 hours after surgery. Main Results: Visual Analog Scale and buprenorphine consumptions in group B were significantly lower than those in group A during the first 4 postoperative hours. In group A, PGE2 in femoral vein increased significantly at T2 (359 +/- 105 pg mL(-1), P < 0.0001), compared with T1 (211 +/- 61 pg mL(-1)) and returned to control values at T3 (252 +/- 77 pg mL(-1)), whereas PGE2 in the cubital vein showed no change. In group B, PGE2 in either the femoral vein or cubital vein showed no change throughout the time course. Conclusions: Preadministration of flurbiprofen suppresses the local production of PGE2 during tourniquet ischemia, resulting in reduced early postoperative pain in patients undergoing knee surgery. (c) 2007 Elsevier Inc. All rights reserved.
引用
收藏
页码:97 / 100
页数:4
相关论文
共 16 条
[1]   Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs [J].
Cryer, B ;
Feldman, M .
AMERICAN JOURNAL OF MEDICINE, 1998, 104 (05) :413-421
[3]   EFFECTS OF SYSTEMIC NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON NOCICEPTION DURING TAIL ISCHEMIA AND ON REPERFUSION HYPERALGESIA IN RATS [J].
GELGOR, L ;
BUTKOW, N ;
MITCHELL, D .
BRITISH JOURNAL OF PHARMACOLOGY, 1992, 105 (02) :412-416
[4]   Effects of diclofenac in the rat tail ischaemia-reperfusion injury model of acute hyperalgesia [J].
Grace, RF ;
Lin, YG ;
Edwards, SR ;
Power, I ;
Mather, LE .
PAIN, 2001, 89 (2-3) :117-125
[5]  
KATZ JF, 1982, CLIN ORTHOP RELAT R, P261
[6]  
KEHLET H, 1993, ANESTH ANALG, V77, P1048
[7]  
Kelly DJ, 2001, CAN J ANAESTH, V48, P1000, DOI 10.1007/BF03016591
[8]   NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND SPINAL NOCICEPTIVE PROCESSING [J].
MCCORMACK, K .
PAIN, 1994, 59 (01) :9-43
[9]   Perioperative intravenous flurbiprofen reduces postoperative pain after abdominal hysterectomy [J].
Nakayama, M ;
Ichinose, H ;
Yamamoto, S ;
Nakabayashi, K ;
Satoh, O ;
Namiki, A .
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 2001, 48 (03) :234-237
[10]   Preemptive analgesic effects of ketorolac in ankle fracture surgery [J].
Norman, PH ;
Daley, MD ;
Lindsey, RW .
ANESTHESIOLOGY, 2001, 94 (04) :599-603