Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery.
OBJECTIVE
Flurbiprofen axetil (FA) is a potent non-steroidal anti-inflammatory drug (NSAID). We examined the effects that peri-operative intravenous administration of FA, combined with thoracic epidural anesthesia and postoperative patient-controlled epidural analgesia (PCEA), have on bowel function, postoperative pain, and cytokine release, after open colorectal surgery.


METHODS
This was a prospective, randomized, double-blind, placebo-controlled study. Forty patients were randomly assigned to one of two groups (n = 20 in each group). The FA group patients received FA 1 mg.kg(-1) iv, 30 min before and six hours after skin incision; whereas the control group patients received an equal volume of intralipid. Blood cytokine levels were measured before FA administration, at the end of surgery, and six hours and 24 hr postoperatively. All patients received postoperative PCEA for pain control. Analgesic efficacy was evaluated for 72 hr postoperatively using visual analogue scale (VAS) pain scores both at rest and during coughing. Gastrointestinal motility was recorded. Temperature and leukocyte count were measured preoperatively, and 24 hr postoperatively.


RESULTS
The times to first bowel movement (87 +/- 23 vs 105 +/- 19 hr, P = 0.008) and first flatus (63 +/- 16 vs 75 +/- 11 hr, P = 0.01) were earlier in the FA group compared to the control group. For the first 24 hr, the pain scores in the FA group were also lower during coughing (P < 0.001 compared to control). The plasma concentrations of interleukin (IL)-6 and IL-8 in the FA group were lower, postoperatively (P < 0.01 and P < 0.05, respectively, compared to control). In contrast, the IL-10 levels were significantly increased at six hours, postoperatively, in the FA group (P = 0.009). The total leukocyte count and the incidence of pyrexia were also lower in patients of the FA group (P = 0.001 and P = 0.006, respectively, compared to control).


CONCLUSIONS
Flurbiprofen axetil may have an anti-inflammatory effect in major abdominal surgery. The combination of perioperative intravenous FA, intraoperative thoracic epidural anesthesia, and postoperative PCEA facilitated recovery of bowel function, enhanced analgesia, and attenuated the cytokine response.
Xu
Yajun
Y
Department of Anesthesiology, Fudan University Cancer Hospital, Shanghai, China.
Tan
Zhiming
Z
Chen
Jiawei
J
Lou
Feifei
F
Chen
Wei
W
D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000758:Anesthesia / Q000379:methods; D001831:Body Temperature / Q000187:drug effects; D016207:Cytokines / Q000378:metabolism; D013505:Digestive System Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D005480:Flurbiprofen / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011355:Prodrugs / Q000008:administration & dosage*; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D016896:Treatment Outcome
D016207:Cytokines; D011355:Prodrugs; D005480:Flurbiprofen; C504422:flurbiprofen axetil