Efficacy of flurbiprofen axetil combined with dezocine in preventing postoperative hyperalgesia in patients undergoing remifentanil-based anesthesia

Objective To investigate the efficacy of flurbiprofen axetil combined with dezocine in preventing postoperative hyperalgesia in the patients undergoing remifentanil-based anesthesia. Methods One hundred patients, of American Society of Anesthesiologist physical statusⅠor Ⅱ, aged 20-60 yr, weighing 48-70 kg, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were randomly divided into 4 groups(n=25 each)using a random number table: control group(group C); flurbiprofen axetil group(group F); dezocine group(group D); flurbiprofen axetil plus dezocine group(group F+ D). Before induction of anesthesia, flurbiprofen axetil 2 mg/kg, dezocine 0.2 mg/kg, and flurbiprofen axetil 1 mg/kg plus dezocine 0.1 mg/kg, were injected intravenously in F, D and F+ D groups, respectively, while the equal volume of normal saline was given in group C. Anesthesia was induced with intravenous injection of midazolam 0.05 mg/kg, sufentanil 0.3 μg/kg, propofol 2.0 mg/kg and cisatracurium 0.2 mg/kg.After tracheal intubation, the patients were mechanically ventilated, and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Anesthesia was maintained with intravenous infusion of remifentanil 0.3 μg·kg-1·min-1 and propofol 4-6 mg·kg-1·h-1, bispectral index value was maintained at 40-60, and muscle relaxation was maintained with intermittent iv boluses of cisatracurium.After admission to the postanesthesia care unit, patient-controlled analgesia was performed with sufentanil 1 μg/ml(100 ml). The patient-controlled analgesia pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at a rate of 2 ml/h.Visual analogue scale score was maintained less than 4.The time for remifentanil infusion was recorded.The consumption of sufentanil were recorded within 0-1, 1-6, 6-12 and 12-24 h periods after surgery, and the development of nausea, vomiting, dizziness and somnolence were also recorded within 24 h after surgery. Results There was no significant difference between the four groups in the amount of sufentanil consumed within 1 h after surgery(P>0.05). Compared with group C, the consumption of sufentanil within 1-24 h after surgery was significantly decreased in F, D and F+ D groups, the incidence of nausea and vomiting was significantly increased in group F, the incidence of dizziness and somnolence was significantly increased in group D(P 0.05). There was no significant change in the amount of sufentanil consumed in different time periods after surgery between F, D and F+ D groups(P>0.05). Compared with group F, the incidence of nausea and vomiting was significantly decreased in group F+ D(P<0.05). Compared with group D, the incidence of dizziness and somnolence was significantly decreased in group F+ D(P<0.05). Conclusion Flurbiprofen axetil combined with dezocine provides better efficacy in preventing postoperative hyperalgesia than either alone in the patients undergoing remifentanil-based anesthesia. Key words: Flurbiprofen; Analgesics, opioid; Piperidines; Hyperalgesia; Postoperative complications