Effects of Flurbiprofen on CRP, TNF-α, IL-6, and Postoperative Pain of Thoracotomy

Abstract

Objective: The aims of this study were to evaluate serum levels of acute phase reactants, such as CRP and cytokines (TNF-α and IL-6) in patients who have undergone thoracotomy and to investigate the effects of flurbiprofen on postoperative inflammatory response.Methods: Forty patients undergoing posterolateral thoracotomy were randomly divided into 2 groups of 20 each. Control group received tramadol (4 x 100 mg) intravenously for four days, and flurbiprofen group received both tramadol (4 x 100 mg) and flurbiprofen (2 x 100 mg). Blood samples were collected before surgery and at the 3th and 168th hours after surgical procedure to measure serum CRP, IL-6, and TNF-α. Pain visual analog scales were recorded daily during the first four postoperative days. Spirometric measurement of forced expiratory volume in the first second (FEV 1) was done before and four days after the operation.Results: The serum CRP, IL-6, and TNF-α levels in both groups increased significantly at 3th hour after thoracotomy. Serum TNF-α levels did not differ significantly between the groups at postoperative 4th day. However, IL-6 and CRP were significantly lower in flurbiprofen group than in control group at the same day (p<0.05). Visual analog scale was significantly lower in flurbiprofen group at 6th, 12th, 48th, 72th, and 96th hours postoperatively (p<0.05). The patients receiving flurbiprofen had higher FEV 1 values when compared with control group at postoperative 4th day.Conclusions: Patients undergoing thoracotomy showed reduced postoperative pain, mean additional analgesic consumption, and serum IL-6 and CRP levels, when flurbiprofen was added to systemic analgesic therapy. Analgesia with anti-inflammatory drug may contribute to the attenuation of the postoperative inflammatory response and prevent postoperative pain in patients undergoing thoracotomy.

Effect on Pain Relief and Inflammatory Response Following Addition of Tenoxicam to Intravenous Patient-Controlled Morphine Analgesia: A Double-Blind, Randomized, Controlled Study in Patients Undergoing Spine Fusion Surgery

“…In fact, T has already demonstrated anti‐inflammatory effects on nociceptive mediators that are implicated in pain processes , such as PGE 2 , IL‐6, and IL‐8 . Additionally, NSAIDs other than T, such as flurbiprofen and parecoxib, have also been reported to attenuate IL‐6 in patients undergoing thoracotomy and surgery for colorectal cancer, respectively . Preventing the increase of these mediators is important, as it can contribute greatly to analgesia via the clinical benefit of decreasing inflammation.…”

Pre-emptive parecoxib and post-operative cognitive function in elderly patients

“…Cognitive function (Wang et al, 2002;Liu et al, 2009;An et al, 2011), was evaluated by measuring the MMSE score (Tombaugh and McIntyre 1992) and a neurological battery (forward and backward digit span, Stroop color interference, and verbal fluency tests) before and within 72 h after surgery, and the occurrence of POCD was recorded as follows: quantitative evaluation of cognitive function in the MMSE was carried out by asking patients a series of questions, including time and place orientation, attention, computing power, short-term memory, immediate recall, ability to copy a figure, etc. The highest score was 30 points, and a decrease of 2 points in the MMSE after surgery compared to the preoperative score or a post-operative decrease (Z-score ࣙ 1.96) in two of the neurological tests was taken as the standard for diagnosing POCD (Casati et al, 2003).…”

Associations between intraoperative nociceptive and early postoperative C-reactive protein levels in patients undergoing non-cardiac surgery under general anesthesia

“…Perioperative managements reducing early postoperative CRP levels could prevent postoperative complications. Previously, reduction of surgical invasion [29][30][31], administration of non-steroidal antiinflammatory drug [32], steroid [33], or β-blocker [34], and Enhanced Recovery After Surgery (ERAS) protocol [31,35], were reported to reduce postoperative CRP levels. Although the effects of anesthetic managements on postoperative CRP levels are controversial so far [36,37], combination with these perioperative managements are required for anesthetic management to reduce postoperative CRP levels for prevention of major complications after surgery.…”