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Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery

Le flurbiprofène axétil intraveineux accélère la restauration de la fonction intestinale après une chirurgie colorectale

Canadian Journal of Anesthesia volume 55, Article number: 414 (2008) Cite this article

Abstract

Purpose: Flurbiprofen axetil (FA) is a potent non-steroidal antiinflammatory drug (NSAID). We examined the effects that perioperative 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−1iv, 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±23vs 105±19 hr,P=0.008) and first flatus (63±16vs 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 andP<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 0.001 andP=0.006, respectively, compared to control).

Conclusion: 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.

Résumé

Objectif: Le flurbiprofène axétil (FA) est un agent antiinflammatoire non stéroïdien (AINS) puissant. Nous avons évalué les effets d’une administration intraveineuse périopératoire de FA, en présence d’une anesthésie péridurale thoracique et d’une analgésie péridurale contrôlée par le patient (APCP) postopératoire, sur la fonction intestinale, la douleur postopératoire et la libération de cytokines à la suite d’une chirurgie colorectale ouverte.

Méthode: Nous avons mené une étude prospective, randomisée, à double insu et contrôlée par placebo. Quarante patients ont été randomisés dans deux groupes (n=20 dans chaque groupe). Les patients du groupe FA ont reçu du FA 1 mg·kg-1 iv 30 min avant et six heures après l’incision de la peau ; les patients du groupe témoin ont, quant à eux, reçu un volume équivalent d’Intralipide. Les niveaux de cytokines plasmatiques ont été mesurés avant l’administration de FA, à la fin de la chirurgie, et six et 24 h après l’opération. Tous les patients ont reçu une APCP pour le contrôle de la douleur. L’efficacité analgésique a été évaluée à 72 h après l’opération sur la base des scores de douleur sur une échelle visuelle analogue (EVA) au repos et à la toux. La motilité gastro-intestinale a été enregistrée. La température et la numération leucocytaire ont été mesurées avant l’opération et 24 h après l’opération.

Résultats: Les temps jusqu’à la première défécation (87±23 vs 105±19 h, P=0,008) et jusqu’aux premières flatuosités (63±16 vs 75±11 h, P=0,01) étaient plus courts dans le groupe FA que dans le groupe témoin. Durant les 24 premières heures, les scores de douleur à la toux étaient également moindres dans le groupe FA (P<0,001 par rapport au groupe témoin). Les concentrations plasmatiques d’interleukine (IL)-6 et IL-8 étaient plus basses dans le groupe FA après l’opération (P<0,01 et P<0,05, respectivement, par rapport au groupe témoin). En revanche, les niveaux IL-10 étaient significativement plus élevés à six heures après l’opération dans le groupe FA (P=0,009). La numération leucocytaire totale et l’incidence de pyrexie étaient également plus bas dans le groupe FA (P=0,001 et P=0,006, respectivement, par rapport au groupe témoin).

Conclusion: Le flurbiprofène axétil pourrait avoir un effet antiinflammatoire lors de chirurgies abdominales majeures. La combinaison de FA intraveineux périopératoire, d’anesthésie péridurale thoracique peropératoire et d’APCP postopératoire a facilité le rétablissement de la fonction intestinale, amélioré l’analgésie, et atténué la sécrétion des cytokines.

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Affiliations

  1. Department of Anesthesiology, Fudan University Cancer Hospital, No.270 Dong-an Road, PC200032, Shanghai, P. R. China

    Yajun Xu MD, Zhiming Tan MD PhD, Jiawei Chen MD PhD, Feifei Lou MD & Wei Chen MD

Authors
  1. Yajun Xu MD
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  2. Zhiming Tan MD PhD
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  3. Jiawei Chen MD PhD
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  4. Feifei Lou MD
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  5. Wei Chen MD
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Corresponding author

Correspondence to Zhiming Tan MD PhD.

Additional information

This study was supported, in part, by a grant from the Ministry of Education of China, Beijing, China.

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Xu, Y., Tan, Z., Chen, J. et al. Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery. Can J Anesth 55, 414 (2008). https://doi.org/10.1007/BF03016307

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  • DOI: https://doi.org/10.1007/BF03016307

Keywords

  • Postoperative Pain
  • Ropivacaine
  • Bowel Function
  • Postoperative Ileus
  • Intralipid