Comparative evaluation of oral flupirtine and oral diclofenac sodium for analgesia and adverse effects in elective abdominal surgeries

Abstract

Background:Flupirtine is a centrally-acting, nonopioid analgesic that interacts with N-methyl-D-aspartate receptors.Aim:The present study was designed to compare analgesic efficacy and adverse effects of orally administered flupirtine and diclofenac sodium for postoperative pain relief.Settings and Design:In a prospective, randomized double-blind study, 100 patients of American Society of Anesthesiologist grade I and II in the age group of 18–65 years of either sex undergoing elective abdominal surgeries were included after taking informed consent.Materials and Methods:The present study started after 12 h of surgery and patients were randomly divided into two groups of 50 each. For postoperative analgesia, group A received flupirtine 100 mg orally and group B received diclofenac sodium 50 mg orally and study drugs were repeated every 6 hourly for 5 days postoperatively. Vital parameters and visual analogue scale (VAS) scores for pain were recorded at 0, 1, 2, 4, 6, 8, 12, 16 and 24 h, and adverse effects were noted for 48 h of the study period.Statistical Analysis:Data were compiled and analyzed statistically using Chi-square test and two-tailed Student's t-test.Results:Visual analogue scores decreased more rapidly in diclofenac group during 1st h, hence there was rapid onset of analgesia in this group as compared to flupirtine group but later on VAS was comparable in both groups at all measured intervals (P > 0.05). Patients in diclofenac group experienced significantly more heartburn (P = 0.00), impaired taste sensation (P < 0.001) and dizziness (P = 0.004) as compared to flupirtine group.Conclusion:Oral flupirtine and diclofenac sodium were equally effective for postoperative analgesia. There was faster onset of analgesia with diclofenac sodium, but flupirtine was better tolerated by the patients because of its minimal adverse effects.

A comparative study of efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery

“…The reduction in pain was significant at all points of time following 48 hours treatment compared to baseline in both the groups. This observation partly correlates with the findings of another study, 10 indicating that though both the study drugs have a slight delay in onset, they have a longer duration of analgesia. Flupirtine used as preemptive analgesic in laparoscopic cholecystectomy surgery had provided adequate pain relief postoperatively in a study conducted by Yadav et al 11 and in postabdominal hysterectomy study conducted by Thapa et al 12 These studies indicate that preemptive use of flupirtine could provide immediate postoperative pain relief; hence, administering this drug preemptively followed by postoperative dosing may be a better method for postoperative analgesia in orthopedic surgeries.…”

“…Similar studies by Attri et al and Ahuja et al, which compared flupirtine with other NSAIDs, also revealed no significant difference between the medications in reducing postoperative pain. 5 , 10 , 14 These studies were conducted on patients undergoing gynecological and other abdominal surgeries unlike the current study which was carried out in limb surgeries. The extensiveness and increased sensitivity of osteoid tissues tend to result in severe postoperative pain following surgeries involving the bone.…”

Evaluation of preoperative flupirtine in ambulatory functional endoscopic sinus surgery: A prospective, double-blind, randomized controlled trial

“…Similarly, Attri et al . [ 28 ] in a study on elective abdominal surgeries found that hemodynamics in flupirtine- and diclofenac-treated groups was quite comparable. However, surprisingly, in our study, mean dose of esmolol and the number of patients receiving the same were significantly high in the control group.…”

Diclofenac and other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are Competitive Antagonists of the human P2X3 Receptor

“…It must also be assumed that there is a high number of unreported cases. In a prospective, randomized clinical trial regarding postoperative administration of Diclofenac, 58% of patients reported impaired taste sensation (Attri et al, 2015). Therefore, it seems likely that diclofenac affects taste sensation due to the inhibition of hP2X2/3R.…”