Abstract
Purpose
Intravenous flurbiprofen, a non-steroidal antiinflammatory drug (NSAID), has been used recently for postoperative pain relief in adults. The drug is also likely to have antiemetic property. The present study was undertaken to investigate the effect of flurbiprofen on postoperative pain and emesis in children undergoing strabismus surgery, which is well known to produce postoperative nausea and vomiting.
Methods
In a prospective, randomised, controlled dinical trial, 90 children aged 2–11 yr received saline (control), flurbiprofen 0.5 mg · kg−1, or flurbiprofen 1 mg · kg−1. Saline and flurbiprofen were administered iv immediately after induction of anaesthesia. Anaesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Postoperative pain was assessed by a blinded observer using an objective pain scale (OPS). No opioids or antiemetics were administered throughout the study. The incidence and frequency of vomiting were compared among groups.
Results
Flurbiprofen 1 mg · kg−1 provided lower OPS (highest) scores during the eight hours after surgery and a reduced requirement for postoperative supplementary analgesic (diclofenac suppository) compared with the other two regimens. The two doses of flurbiprofen failed to decrease the incidence and frequency of vomiting.
Conclusion
These data suggest that preoperative flurbiprofen 1 mg · kg−1 iv is a simple and effective approach to postoperative pain relief but not to the prevention of emesis following paediatric strabismus surgery.
Résumé
Objectif
Le flurbiprofène intraveineux, un anti-inflammatoire non stéroïdien (AINS), est utilisé depuis peu pour le soulagement de la douleur postopératoire chez l’adulte. On pense que ce médicament pourrait en outre avoir des propriétés antiémétiques. La présente étude visait à étudier les effets du flurbiprofène sur la douleur postopératoire et les vomissements chez des enfants opérés pour strabisme, intervention reconnue comme cause de nausées et de vomissements postopératoires.
Méthodes
Au cours d’une étude prospective aléatoire contrôlée, 90 enfants âgés de 2 à 11 ans ont reçu du sol.phys.(contrôle), du flurbiprofène 0.5 mg · kg−1 ou du flurbiprofène 1 mg · kg−1. Le soluté physiologique et le flurbiprofène étaient administrés iv immédiatement après l’induction de l’anesthésie. L’anesthésie était induite et maintenue avec du sévoflurane et du protoxyde d’azote en oxygène. La douleur postopératoire était évaluée par un observateur indépendant sur une échelle objective de la douleur (EOD). Aucun morphinique ou antiémétique n’était administré pendant l’étude. L’incidence et la fréquence des vomissements étaient comparées entre les groupes.
Résultats
Le flurbiprofène I mg · kg−1 a produit des scores EOB inférieurs pendant les huit heures qui suivaient la chirurgie et a diminué les besoins d’analgésie postopératoire supplémentaire (diclofénac en suppositoire) comparativement aux deux autres alternatives. Les deux posologies de flurbiprofène n’ont pas diminué l’incidence et la fréquence des vomissements.
Conclusion
Ces données suggèrent que l’administration préopératoire de flurbiprofène 1 mg · kg−1 iv chez les enfants soulage efficacement la douleur postopératoire mais ne prévient pas les vomissements après la chirurgie du strabisme.
Article PDF
Avoid common mistakes on your manuscript.
References
France NK. Anesthesia for pédiatric ophthalmologic surgery.In: Gregory GA (Ed.). Pédiatric Anesthesia, 2nd ed. New York: Churchill Livingstone Inc., 1989: 1065–95.
Munro HM, Riegger LQ Reynolds PI, Wilton NCT, Lewis IH. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth 1994; 72: 624–8.
Rose JB, Martin TM, Corddry DH, Zagnoev M, Kettrick RG. Ondansetron reduces the incidence and severity of poststrabismus repair vomiting in children. Anesth Analg 1994; 79: 486–9.
Kymer PJ, Brown RE Jr, Lawhorn CD, Jones E, Pearce L. The effects of oral droperidol versus oral metoclopramide versus both oral droperidol and metoclopramide on postoperative vomiting when used as a premedicant for strabismus surgery. J Clin Anesth 1995; 7: 35–9.
Tramér M, Moore A, McQuay H. Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method. Br J Anaesth 1995; 75: 556–61.
Vener DF, Carr AS, Sikich N, Bissonnette B, Lerman J. Dimenhydrinate decreases vomiting after strabismus surgery in children. Anesth Analg 1996; 82: 728–31.
Kantor TG. Physiology and treatment of pain and inflammation. Analgesic effects of flurbiprofen. Am J Med 1986; 80(Suppl 3A): 3–9.
Maclean D. A comparison of flurbiprofen and paracetamol in the treatment of primary dysmenorrhoea. J Int Med Res 1983; 11(Suppl 2): 1–5.
Forbes JA, Yorio CC, Selinger LR, Rosenmertz SK, Beaver WT. An evaluation of flurbiprofen, aspirin, and placebo in postoperative oral surgery pain. Pharmacotherapy 1989; 9: 66–73.
Sunshine A, Marrero I, Olson N, McCormick N, Laska EM. Comparative study of flurbiprofen, zomepirac sodium, acetaminophen plus codeine, and acetaminophen for the relief of postsurgical dental pain. Am J Med 1986; 80 (Suppl 3A): 50–4.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–34.
Casey WF, Rice LJ, Hannallah RS, Broadman L, Norden JM, Guzzetta P. A comparison between bupivacaine instillation versus ilioinguinal/iliohypogastric nerve block for postoperative analgesia following inguinal herniorrhaphy in children. Anesthesiology 1990; 72: 637–9.
Mikawa K, Nishina K, Maekawa N, Obara H. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg 1996; 82: 225–30.
Mikawa K, Nishina K, Maekawa N, Asano M, Obara H. Oral clonidine premedication reduces vomiting in children after strabismus surgery. Can J Anaesth 1995; 42: 977–81.
Moores MA, Wandless JG, Fell D. Paediatric postoperative analgesia. A comparison of rectal diclofenac with caudal bupivacaine after inguinal herniotomy. Anaesthesia 1990; 45: 156–8.
Baer GA, Rorarius MGF, Kolehmainen S, Selin S. The effect of paracetamol or diclofenac administered before operation on postoperative pain and behaviour after adenoidectomy in small children. Anaesthesia 1992; 47: 1078–80.
Yamamoto I, Yukioka H, Fujimori M. Clinical study of postoperative sedation in pediatric patients —effects of inhalation anesthetics and postoperative analgesics. (Japanese) Masui 1994; 43: 1191–5.
Lerman J. Study design in clinical research: sample size estimation and power analysis. Can J Anaesth 1996; 43: 184–91.
Watcha MF, Smith I. Cost-effectiveness analysis of antiemetic therapy for ambulatory surgery. J Clin Anesth 1994; 6: 370–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mikawa, K., Nishina, K., Maekawa, N. et al. Dose-response of flurbiprofen on postoperative pain and emesis after paediatric strabismus surgery. Can J Anesth 44, 95–98 (1997). https://doi.org/10.1007/BF03014332
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03014332