title: Efficacy and safety of flurbiprofen axetil in the prevention of pain on propofol injection: a systematic review and meta-analysis.
abstract: BACKGROUND
  Pain on injection is an acknowledged adverse effect (AE) of propofol administration for the induction of general anesthesia. Flurbiprofen axetil has been reported to reduce the pain of injection. However, results of published papers on the efficacy of flurbiprofen axetil in managing pain on injection of propofol are inconsistent.
  
  
  METHODS
  We conducted a comprehensive meta-analysis of studies to appraise the efficacy and safety of flurbiprofen axetil for controlling pain induced by propofol injection. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed- or random-effects models, depending upon the heterogeneity of the included trials.
  
  
  RESULTS
  Compared with the placebo group, flurbiprofen axetil allows more patients to have no pain (RR 3.51, 95% CI 2.22-5.55, p=0.000), and decreases the cumulative number of patients with mild, moderate, and severe pain on injecting propofol (RR 0.70, 95% CI 0.58-0.86, p=0.000; RR 0.59, 95% CI 0.46-0.75, p=0.000; RR 0.25, 95% CI 0.16-0.38, p=0.000, respectively). In the stratified analysis by the doses, flurbiprofen axetil at a dose of over 50 mg was found to be effective in reducing propofol-induced pain on injection; however, there were no significant differences in relieving pain between treatment and placebo groups with flurbiprofen axetil at a dose of 25 mg. In terms of drug safety, there were no adverse effects (AEs) reported between flurbiprofen axetil-based regimens and placebo regimens.
  
  
  CONCLUSIONS
  Flurbiprofen axetil, an injectable prodrug of flurbiprofen, can significantly prevent or relieve the pain induced by propofol injection. More studies are required to assess its adverse effects.
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Lieliang
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Juan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Xunlei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Hongyu
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Yamei
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Yi
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Hongwei
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (mainland).
authors.forename: Hongguang
authors.initials: H
authors.lastname: Bao
mesh_terms: D002986:Clinical Trials as Topic; D005480:Flurbiprofen / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*; D017594:Publication Bias; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005480:Flurbiprofen; C504422:flurbiprofen axetil; D015742:Propofol