Pain Management After Spinal Fusion Surgery Using Continuous Wound Infusion Of Flrubiprofen Axetil

BackgroundPain has been recognized as a problem of global proportion,and postoperative pain is one of the most common types of pain.Post-operative pain is a complex multidimensional consious experience that incorporates sensory,cognitive,affective and behaviouralcomponent,and that usually occus in response to tissue trauma.Whereas response to acute pain may be adaptive,they can have adverseliy physiologic and phycological consequences that are thought to contribute to organ dysfunction and postoperative morbidity.It has been assumed that sufficient pain relief will improve the surgical outcome with reducing the incidence of postoperative complications and morbidity,need for hospitalization and convalescence,and improve patients,satisfaction.There is a common consensus that the optimal pain relief is a prerequisite for early postoperative recovery.So prompt and adequate treatment of acute pain is imperative.Fifty to seventy percent of surgical patients suffer middle-intensity or above pains after sergical procedures,and which not only causes the patients' physiological and psychological problems,but also affects the patients'living quality.Therefore postoperative pain and its mechanism have been important aspects in medical research for last ren years.There are many ways for postoperative analgesia in clinic.Opioid agentsare commonly used anslgesics for postopeative pain relief,but they are associated with a number of adverse effects,such as respiratory depression,alteration in mental status,ileus,constipaton,nausea and vomiting,which severly impact its analgesic quality.Multimodal pain therapy that combines opioid with other anslgesics has been recommended in postoperative surgical patients to reduce the need for opioids and improve overall analgesic management.Nonsteroidal anti-inglammatory drugs(NSAIDs) have been used for postoperative analgesia only after some new types of drugs were developed.They cause fewer side effects,and have effects of local anti-inflammatory and analgesia.But they also have side effects,including gastrointestinal ulceration and bleeding,kidey toxicity and decreased platelet aggregation.Developed on the basis of the concept of drug delivery system,flurbiprofen axetil injection(trade name is Kaifen) is a new non-steroid preparation that enveloping flurbiprofen ester in the drug carrier of lipid microsphere.It is the only non-steroid prepara-tion at present that can be administered intravenously. Flurbiprofen ester is the prodrug precipitated by flurbiprofen estrification which has lipophilicify.Its mechanism of action is mainly to inhibit the activity of cyclooxy-genase in the arachidonic acid cascade chute,which can inhibit the synthesis of prostaglandin that can cause pain and inflammatory reac-tion.Then,it can take analgesic effect.Its analgesic action is higher than acenterine,even pentazocine.Except for the sole adminis-tration,flurbiprofen axetil injecction can be coadministered with opioid without adverse effect aggravation,which can enhance the analgesic effect with no central inhibitory action.Incisional use of local anaesthetic drugs for treating post-operative pain is an attractive technique because of its simplicity,safety and low cost.The use of local anaesthetic in the wound or joint has several advantages over peripheral blocks for post-operative analgesia.Numerous studies have evaluated the technique in recent years and several reviews have been published.Most of the literature is based on single-dose studies;however,in recent years catheter techniques are being increasingly used for hospitilized patients and outpatients.The introduction of catheter techniques has greatly increased the usefulness and flexibility of incisional and intra-articular analgesia for several days after surgery.The technique is simple to perform;catheters can be placed under direct or arthroscopic visualization.This eliminates the risk of inadvertent penetration of vascular or vascular or neural structures.Additionally,only the area of surgery is affected allowing normal use of the extremity and early rebabilitation.The incisional and intra-articular use of opioids and a variety of non-opioids alone or incombination with local anaesthetics have also been studied.MethodsEighty adult patients,ASA statusⅠorⅡ,30-60 yr,and scheduled for elective lunbar spinal fusion surgery under general anesthesia were randomly assigned to one of four groups to receive a 48-h continuous intrawound infusion with 200 ml containing 200 mg flrubiprofen axetil(group W),0.2%ropivacaine(group R),or saline(group S) via a catheter at the end of the operation,and intravenous 200 ml containing 200 mg flrubiprofen axetil(groupⅣ),.The four groups also received a 48-h fentanyl (1.0mg/100ml) PCIA with bolus dose of 1ml/h,lockout time of 10 min,and without basal infusion for postoperative pain relief.Pain was assessed using visual analogue scores(VAS).Fentanyl consumption of PCIA,nausea,vomiting and sedation scores were recorded at 1,4,12,24,and 48 h after surgery.ResultsPostoperative pain scores at rest and movement were lower in group A than group B and C,and in group B than group C(P<0.05).Postoperative fentanyl consumption was less in group W(240μg;95%confidence interval,199-281) than in groupⅣ(333μg;95%confidence interval,314-352) and R(465.3μg;95%confidence interval,431-498)(P<0.05).ConclusionsAfter lunbar spinal fusion surgery,continuous intrawound infusion with flrubiprofen axetil provides a better postoperative analgesia and greater opioidsparing effect than the same dose administered intravenously when combined with PCIA of fentanyl.