Efficacy and safety of flurbiprofen axetil in the prevention of pain on propofol injection: A systematic review and meta-analysis

Abstract

BackgroundPain on injection is an acknowledged adverse effect (AE) of propofol administration for the induction of general anesthesia. Flurbiprofen axetil has been reported to reduce the pain of injection. However, results of published papers on the efficacy of flurbiprofen axetil in managing pain on injection of propofol are inconsistent.Material/MethodsWe conducted a comprehensive meta-analysis of studies to appraise the efficacy and safety of flurbiprofen axetil for controlling pain induced by propofol injection. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed- or random-effects models, depending upon the heterogeneity of the included trials.ResultsCompared with the placebo group, flurbiprofen axetil allows more patients to have no pain (RR 3.51, 95% CI 2.22–5.55, p=0.000), and decreases the cumulative number of patients with mild, moderate, and severe pain on injecting propofol (RR 0.70, 95% CI 0.58–0.86, p=0.000; RR 0.59, 95% CI 0.46–0.75, p=0.000; RR 0.25, 95% CI 0.16–0.38, p=0.000, respectively). In the stratified analysis by the doses, flurbiprofen axetil at a dose of over 50 mg was found to be effective in reducing propofol-induced pain on injection; however, there were no significant differences in relieving pain between treatment and placebo groups with flurbiprofen axetil at a dose of 25 mg. In terms of drug safety, there were no adverse effects (AEs) reported between flurbiprofen axetil-based regimens and placebo regimens.ConclusionsFlurbiprofen axetil, an injectable prodrug of flurbiprofen, can significantly prevent or relieve the pain induced by propofol injection. More studies are required to assess its adverse effects.

Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

“…However, Mihara and colleagues [ 27 ] evaluated the efficacy of flurbiprofen axetil for postoperative pain management after laparoscopic colectomy, and the conclusion was satisfactory. Similar to other studies [ 15 , 28 ], our present study suggested preoperative administration of flurbiprofen axetil had preemptive analgesia effects, which was supported by the results that flurbiprofen axetil decreased the VAS at 4, 6, 12, and 24 h after surgery and postoperative tramadol consumption. Furthermore, postoperative administration of flurbiprofen axetil in PCIA pump enhanced the analgesic effects of sufentanil.…”

Do Different Cyclooxygenase Inhibitors Impair Rotator Cuff Healing in a Rabbit Model?

“…This lipid microsphere nonselective COX inhibitor can be delivered targeting the inflammation site. [ 17 18 ] In our study, flurbiprofen axetil delayed tendon healing significantly compared with ibuprofen at 3 weeks after tendon repair, although both drugs are nonselective COX inhibitors. This significance difference disappeared by 6 weeks after surgery, which means that different routes of administering drugs have limited effects on tendon healing at the very early stage.…”

Population pharmacokinetic modeling of flurbiprofen, the active metabolite of flurbiprofen axetil, in Chinese patients with postoperative pain

“…The exponential model was used to describe the interindividual variability of the PK parameters: where P i is the OK parameter for the i th individual, including the clearance ( CL ), the apparent volume of distribution ( V d ), and the elimination rate constant ( K e ), θ is the typical population value of the corresponding parameter in this population, and η i is a random variable for the i th individual following normal distribution with a mean of 0 and a variance of ω. 2 …”

“… 1 Flurbiprofen axetil, an ester prodrug of flurbiprofen, is one of the most commonly used nonsteroidal anti-inflammatory drugs worldwide indicated for the treatment of postoperative pain. 2 It is a lipid-microsphere-carrier targeting preparation to reduce venous irritation caused by flurbiprofen. 3 Flurbiprofen axetil is rapidly metabolized to flurbiprofen through the hydrolysis of esterase, which is the pharmacologically active moiety.…”