title: Preadministration of flurbiprofen suppresses prostaglandin production and postoperative pain in orthopedic patients undergoing tourniquet inflation.
abstract: OBJECTIVE
  To evaluate the effect of preadministration of flurbiprofen on the plasma concentrations of prostaglandin E2 (PGE2) and postoperative pain.
  
  
  METHODS
  Prospective, randomized, controlled and double-blind study.
  
  
  METHODS
  Inpatient surgery at Nagasaki Rosai Hospital.
  
  
  METHODS
  32 ASA physical status I to II patients scheduled for total knee arthroplasty or open anterior cruciate ligament reconstruction.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
authors: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo 857-0134, Japan. mtakada@net.nagasaki-u.ac.jp
authors: Masafumi
authors: M
authors: Takada
authors: Makoto
authors: M
authors: Fukusaki
authors: Yoshiaki
authors: Y
authors: Terao
authors: Kazunori
authors: K
authors: Yamashita
authors: Chiaki
authors: C
authors: Inadomi
authors: Miwako
authors: M
authors: Takada
authors: Koji
authors: K
authors: Sumikawa
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016118:Anterior Cruciate Ligament / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D002047:Buprenorphine / Q000008:administration & dosage; D015232:Dinoprostone / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D005480:Flurbiprofen / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011229:Preanesthetic Medication / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D014111:Tourniquets
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D002047:Buprenorphine; D005480:Flurbiprofen; D015232:Dinoprostone