Preoperative butorphanol and flurbiprofen axetil therapy attenuates remifentanil-induced hyperalgesia after laparoscopic gynaecological surgery: a randomized double-blind controlled trial.

Abstract

BACKGROUND:

Several studies indicate that remifentanil exposure may engender opioid-induced hyperalgesia. Butorphanol and flurbiprofen axetil are proposed as adjunctive analgesics for postoperative pain control. This randomized double-blind controlled study was designed to investigate the antihyperalgesic effects of butorphanol combined with flurbiprofen axetil on opioid-induced hyperalgesia.

METHODS:

One hundred and twenty patients undergoing elective laparoscopic gynaecological surgery with sevoflurane anaesthesia were randomized to one of four groups, as follows: intraoperative sufentanil 0.30 µg kg-1 (Group S); remifentanil 0.30 µg kg-1 min-1 (Group R); intraoperative remifentanil and pre-anaesthesia butorphanol 20 µg kg-1 (Group B); or intraoperative remifentanil and pre-anaesthesia butorphanol 10 µg kg-1 combined with flurbiprofen axetil 0.5 mg kg-1 (Group BF). Sufentanil was used to control postoperative pain. The threshold and area of postoperative mechanical hyperalgesia were measured with Von Frey filaments. Pain intensity, sufentanil consumption, and side-effects were recorded for 24 h after surgery.

RESULTS:

Compared with Group S, remifentanil anaesthesia increased the pain score, postoperative sufentanil consumption, and area of hyperalgesia [mean 49.9 (sd 8.6) vs 60.5 (10.0) cm2, P<0.001] and reduced the hyperalgesia threshold on the dominant inner forearm [mean 89.5 (sd 23.4) vs 60.6 (22.6) g, P=0.004]. Compared with Group R, the pain score, sufentanil consumption, and area of hyperalgesia were reduced and hyperalgesia threshold was elevated likewise in Groups B and BF. However, the efficacy in Group BF was higher than in Group B (P=0.021).

CONCLUSIONS:

The preoperative combination of butorphanol and flurbiprofen axetil effectively ameliorated opioid-induced hyperalgesia in patients undergoing laparoscopic gynaecological surgery under sevoflurane-remifentanil anaesthesia.

CLINICAL TRIAL REGISTRATION:

NCT02043366.

• Authors: L Zhang, R Shu, Q Zhao, Y Li, Y Yu, G Wang
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 117 Issue 4 Pg. 504-511 (Oct 2016) ISSN: 1471-6771 [Electronic] England
• PMID: 28077539 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Piperidines
• Flurbiprofen
• flurbiprofen axetil
• Remifentanil
• Butorphanol

Topics

• Adult
• Butorphanol (administration & dosage)
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Flurbiprofen (administration & dosage, analogs & derivatives)
• Gynecologic Surgical Procedures
• Humans
• Hyperalgesia (chemically induced, drug therapy)
• Laparoscopy
• Middle Aged
• Piperidines (adverse effects)
• Remifentanil