|Table of Contents|

Analgesic effects of 2 nonsteroidal anti-inflammatory drugs respectively combined with hydromorphone in postoperative analgesia after thoracic surgery: a randomized, double blind, controlled clinical study

(PDF)

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

Issue:
2018年第11期
Page:
1011-1016
Research Field:
临床医学
Publishing date:

Info

Title:

Analgesic effects of 2 nonsteroidal anti-inflammatory drugs respectively combined with hydromorphone in postoperative analgesia after thoracic surgery: a randomized, double blind, controlled clinical study

Author(s):

YAN Guangming CHEN Jie YANG Guiying DUAN Guangyou DU Zhiyong YU Zubin PENG Jing LIAO Wei LI Hong

Department of Anesthesiology,Department of Thoracic Surgery, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

Keywords:

nonsteroidal anti-inflammatory drugs inflammatory cytokines patient controlled intravenous analgesia thoracoscopic surge

PACS:
R614.24; R656; R971.1
DOI:
-
Abstract:

Objective   To compare the postoperative analgesic effects of parecoxib and flurbiprofen axetil combined with hydromorphone respectively on the patients undergoing elective thoracoscopic surgery, and determine the effects on inflammation and postoperative pulmonary complications. Methods    A total of 156 patients who underwent elective thoracoscopic surgery and then received postoperative patientcontrolled intravenous analgesia (PCIA, 0.15 mg/kg hydromorphone+0.6 mg ramosetron diluted with saline to 200 mL, infusion speed: 4 mL/h, single PCA dose: 1 mL, and lock time: 15 min) in our hospital from February to November 2017 were prospectively enrolled in this study. They were randomly divided into 3 groups according to the intraoperative analgesic agents they received, that is, 40 mg parecoxib sodium (group A), 50 mg flurbiprofen (group B) and  5 mL normal saline (group C), which were intravenously injected in 30 min before the end of surgery. Numerical rating scale (NRS) of postoperative pain and adverse reactions at 6, 12, 24, 48 h after the operation, postoperative pulmonary complications, inflammatory cytokines (C-reaction protein, white cell count, and percentage of neutrophils) and blood gas analysis at 12 h postoperatively and length of hospital stay were recorded and compared between the 2 groups. Results    Compared with group C, the NRS score was significantly lower in group A and group B at 6 and 12 h after operation (P<0.05), and that of group B was lower than that of group A though no statistical difference (P>0.05). The serum C-reaction protein level at 3 d after operation was significantly decreased in groups A and B than group C (P<0.05), and the level of group B was lower than that of group A but there was no significant difference (P>0.05). No significant differences were found in the scores of nausea and vomiting and the incidence of postoperative pulmonary complications in the intragroup and intergroup comparison (P>0.05). Compared with group C, the mean length of hospitalization was significantly shorter in group B (P<0.05), and there was no significant difference between group A and group C and between group A and group B (P>0.05), though the length was 1.32 d shorter in group B than group A.  Conclusion     Application of both parecoxib sodium or flurbiprofen axetil in 30 min before the end of surgery can enhance the analgesic effect of hydromorphone after thoracoscopic surgery, reduce inflammation and help patients recover after operation. However, flurbiprofen axetil seems to be better than parecoxib sodium.
 

References:

[1]SCHILLING T, KOZIAN A, SENTURK M, et al. Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients[J]. Anesthesiology, 2011,115(1):65-74.DOI: 10.1097/ALN.0b013e318214b9de.
[2]REFAI M, BRUNELLI A, SALATI M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection[J]. Eur J Cardiothorac Surg,2012,41(4):820-822.DOI:10.1093/ejcts/ezr126.
[3]FELDEN L, WALTER C, HARDER S, et al. Comparative clinical effects of hydromorphone and morphine: a metaanalysis[J]. Br J Anaesth,2011,107(3):319-328.DOI:10.1093/bja/aer232.
[4]GUPTA A, BAH M. NSAIDs in the treatment of postoperative pain[J]. Curr Pain Headache Rep,2016,20(11):62. DOI:10.1007/s1191601605917.
[5]BOONSTRA A M, STEWART R E, K KE A J A, et al. Cutoff points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing[J]. Front Psychol,2016,7:1466.DOI:10.3389/fpsyg.2016.01466.
[6]AGOSTINI P, CIESLIK H, RATHINAM S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?[J]. Thorax,2010,65(9):815-818. DOI:10.1136/thx.2009.123083.
[7]M HLING B, OREND K H, SUNDERPLASSMANN L. Fast track in thoracic surgery[J]. Chirurg,2009,80(8):706-710. DOI:10.1007/s001040091678z.
[8]WU C Y, Chi P L, Hsieh H L, et al. TLR4dependent induction of vascular adhesion molecule1 in rheumatoid arthritis  synovial fibroblasts: Roles of cytosolic phospholipase A(2)alpha/cyclooxygenase2[J]. J Cell Physiol,2010,223(2):480-491. DOI:10.1002/jcp.22059.
[9]DIRKMANN D, GROEBEN H, FARHAN H, et al. Effects of parecoxib on analgesia benefit and blood loss following open prostatectomy: a multicentre randomized trial[J]. BMC Anesthesiol,2015,15:31. DOI:10.1186/s128710150015y.
[10]WILSON D J, SCHUTTE S M, ABEL S R. Comparing the efficacy of ophthalmic NSAIDs in common indications: a literature review to support costeffective prescribing[J]. Ann Pharmacother,2015,49(6):727-734.DOI: 10.1177/1060028015574593.
[11]宋云,闵苏,程波,等. 帕瑞昔布钠与氟比洛芬酯用于甲状腺术后的镇痛效果及对血流动力学与炎性细胞因子的影响比较[J]. 现代生物医学进展,2017,17(13):2459-2462, 2494. DOI:10.13241/j.cnki.pmb.2017.13.015.
SONG Y,MIN S,CHENG B,et al. Comparison of the postoperative analgesic effect of parecoxib sodium and flurbiprofen axetil for thyroid operation and their impact on the hemodynamics and inflammatory cytokines[J]. Prog Mod Biomed, 2017,17(13):2459-2462, 2494. DOI:10.13241/j.cnki.pmb.2017.13.015.
[12]兰岭,申乐,黄宇光. 术后慢性疼痛相关炎性反应及炎性细胞因子研究进展[J]. 中国医学科学院学报,2015,37(6):741-745. DOI:10.3881/j.issn.1000503X.2015.06.019.
LAN L, SHEN L, HUANG Y G. Roles of inflammatory reaction and cytokines in chronic postsurgical pain[J].ActaAcad Med Sin, 2015,37(6):741-745. DOI:10.3881/j.issn.1000503X.2015.06.019.
[13]FARES K M, MOHAMED S A, HAMZA H M, et al. Effect of thoracic epidural analgesia on proinflammatory cytokines in patients subjected to protective lung ventilation during Ivor Lewis esophagectomy[J]. Pain Physician,2014,17(4):305-315.
[14]李清,王宇,罗向红,等. 帕瑞昔布钠超前镇痛对老年开胸手术患者围术期炎性细胞因子的影响[J]. 湖北医药学院学报,2014(2):141-145. DOI:10.13819/j.issn.10069674.2014.02.011.
LI Q,WANG Y,LUO X H, et al. Effects of parecoxib preemptive analgesia on inflammatory factors in old patients undergoing thoracotomy[J].  J Hubei Univ Med, 2014(2):141-145. DOI:10.13819/j.issn.10069674.2014.02.011.
[15]吉春宇,方文涛. 盐酸氨溴索在胸外科围手术期的肺功能保护作用[J]. 中华胸心血管外科杂志,2013,29(12):767-768. DOI:10.3760/cma.j.issn.1001 4497.2013.12.020.
JI C Y,FANG W T.Protective effect of ambroxol hydrochloride on lung in perioperative period of thoracic surgery[J].Chin J Thorac Cardiovasc Surg,2013,29(12):767-768.DOI:10.3760/cma.j.issn.1001 4497.2013.12.020.
[16]FELDEN L, WALTER C, HARDER S, et al. Comparative clinical effects of hydromorphone and morphine: a metaanalysis[J]. Br J Anaesth,2011,107(3):319-328. DOI:10.1093/bja/aer232.
[17]SAARI T I, IHMSEN H, MELL J, et al. Influence of intensive care treatment on the protein binding of sufentanil and hydromorphone during pain therapy in postoperative cardiac surgery patients[J]. Br J Anaesth,2014,113(4):677-687. DOI:10.1093/bja/aeu160.
[18]CHAGASPAULA D A, OLIVEIRA T B, FALEIRO D P, et al. Outstanding antiinflammatory potential of selected asteraceae species through the potent dual inhibition of cyclooxygenase1 and 5lipoxygenase[J]. Planta Med,2015,81(14):1296-1307. DOI:10.1055/s00351546206.
[19]WU D, ZHENG S, LI W, et al. Novel biphasic role of resolvin D1 on expression of cyclooxygenase2 in lipopolysaccharidestimulated lung fibroblasts is partly through PI3K/AKT and ERK2 pathways[J]. Mediators Inflamm,2013,2013:964012. DOI:10.1155/2013/964012.
[20]MEI C, LI B, YIN Q, et al. Liquid chromatographytandem mass spectrometry for the quantification of flurbiprofen in human plasma and its application in a study of bioequivalence[J]. J Chromatogr B Analyt Technol Biomed Life Sci,2015,993-994:69-74. DOI:10.1016/j.jchromb.2015.04.037.
[21]左岚,陈旭,郭伟林,等. 氟比洛芬酯微乳注射液大鼠组织分布及靶向性研究[J]. 中国药师,2015,18(6):932-935.
ZUO L, CHEN X, GUO W L, et al.Study on distribution in rats and targeting property of flurbiprofen axetil microemulsion[J]. China Pharmacist,2015,18(6):932-935.
[22]ZHANG H, GU J, FENG Y, et al. Absorption kinetics of flurbiprofen axetil microspheres in cerebrospinal fluid: A pilot study[J]. Int J Clin Pharmacol Ther,2017,55(11):875-880. DOI:10.5414/CP203092.
[23]WU T T, WANG Z G, OU W L, et al. Intravenous flurbiprofen axetil enhances analgesic effect of opioids in patientswith refractory cancer pain by increasing plasma βendorphin[J]. Asian Pac J Cancer Prev,2014,15(24):10855-10860.DOI:10.7314/APJCP.2014.15.24.10855.

Memo

Memo:
-
Last Update: 2018-06-14