Therapeutic Effect Of Flurbiprofen Axetil Or Tramadol For Postoperative Analgesia After Lower Limb Fracture

Objective: To observe the efficacy of flurbiprofen axetil or tramadol for postoperative analgesia on the pain under quiescent state and motion state after lower limb fracture respectively.Methods: This research was a randomized controlled study. Sixty cases, ASA I~II, of lower limb fracture selected with the age of 20~65 years were randomly divided into three groups that twenty cases in each group, ten cases are men, and the other are women. All patients were accepted L3-4 or L2-3 puncture for combined spinal-epidural analgesia (CSEA). 15min before the operation was ended, GroupⅠwere infused flurbiprofen axetil 50mg, GroupⅡwere given tramadol 100mg, GroupⅢwere injected normal saline solution 10ml , all drugs were diluted to 10ml with normal saline solution and infused intravenously slowly; After surgery, GroupⅠwere given flurbiprofen axetil 150mg plus sufentanil (2μg/kg) and ramosetron 0.6mg via patient-controlled intravenous analgesia(PCIA), GroupⅡwere given tramadol 500mg plus sufentanil (2μg/kg) and ramosetron 0.6mg via PICA, GroupⅢwere given sufentanil (2μg/kg) and ramosetron 0.6mg via PICA, all the postoperative analgesia were added into normal saline solution to 100ml, Loading dose(10ml) + continuous background infusion(2ml/h)+PCIA volume(0.5ml/time), lockout time 15min. The Visual Analogue Scale(VAS) score,Ramsay score(RSS) during postoperative 4,6,8,24,48h, effective demanding times for PCIA at every time points postoperative and incidence of adverse effects including nausea,vomiting,pruritus cutanea,somnolence,respiratory depression and urinary retention during the period of postoperative 48h were recorded respectively. Results: The VAS of all time points postoperative: (1) under quiescent state, although the VAS of three groups were different, but all could reach satisfactory analgesic effect, meet the requirement of patients, so there were no statistically significant among them(P>0.05); (2) under motion state, the VAS of three groups on 4h postoperative had a similar results(P>0.05); except the 4h point postoperative, the VAS of groupⅠwere lower than that of groupⅡand groupⅢ(P<0.05), while the VAS of groupⅡwere below that of groupⅢ, which had statistical difference(P<0.05). The effective demanding times for PCIA within each time point: except the 4h point postoperative, the times of both groupⅠand groupⅡwere less than that of groupⅢobviously(P<0.05), although the times of groupⅠand groupⅡhad a little difference but no statistical significance(P>0.05). Incidence of adverse effects among three groups: (1)All the patients of three groups did not appear vomiting,respiratory inhibition and pruritus cutanea. (2) There were four patients appearing nausea reaction in groupⅡ, while both only one patient appearing such adverse in groupⅠand groupⅢ, there were statistically significant compared with groupⅡ(P<0.05); (3) Three patients presented on giddy sleepiness, but no patients in groupⅠand groupⅢappeared giddy sleepiness symptom, so compared with groupⅡ, there were statistically significant (P<0.05) too; (4) Because of being selected CSEA, all the patients had catheters before surgery, so we could't evaluate the adverse reaction of urinary retention after surgery. However, the RSS among three groups had different results but no significance (P>0.05).Conclusion: Fracture postoperative analgesia, all the three analgesic modes can reach satisfactory analgesic effect under quiescent state; while, under motion state, the analgesic effect of flurbiprofen axetil is much better than that of tramadol and sufentanil. Besides, flurbiprofen axetil can also reduce adverse effects of analgesics, and decrease the dosages of sufentanil.