The effect of flurbiprofen oral spray and ibuprofen vs ibuprofen alone on postoperative tonsillectomy pain: An open, randomised, controlled trial

Türk, Bilge; Akpınar, Meltem; Erol, Zeynep; Kaya, Kerem Sami; Ünsal, Özlem; Coşkun, Berna Uslu

doi:10.1111/coa.13058

Cited by 5 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,[19][20][21][22][23] The efficacy of flurbiprofen spray has been evaluated in three randomized controlled studies in post-tonsillectomy pain and shown to be effective. [24][25][26] Flurbiprofen is available in spray and lozenge formulations at a low dose for relief of the sore throat pain due to inflammation. Local delivery of lowdose flurbiprofen may reduce the potential for systemic adverse effects compared with oral high-dose NSAIDs.…”

Section: Introductionmentioning

confidence: 99%

<p>Determination of the Permeation and Penetration of Flurbiprofen into Cadaveric Human Pharynx Tissue</p>

Turner¹,

Wevrett²,

Edmunds³

et al. 2020

CPAA

View full text Add to dashboard Cite

Objective: Flurbiprofen 8.75 mg spray and lozenge have a rapid onset of action for sore throat relief, suggesting local action, although tissue penetration and the mechanism of local relief have not been determined. This investigation aimed to quantify the permeation and penetration of flurbiprofen, applied as local pharmaceutical forms, into full-thickness cadaveric human mucosal pharynx tissue, representing the clinical scenario as far as possible. Methods: A validated high-performance liquid chromatography method quantified the permeation and penetration of flurbiprofen (spray and lozenge formulations) into human cadaveric pharynx tissue using a micro Franz cell model mimicking physiological and anatomical conditions. Full-thickness mucosal pharynx tissue, consisting of oral epithelium, basement membrane, and lamina propria, was utilized to imitate the in vivo setting. Flurbiprofen was analyzed on the surface of the pharynx tissue, within the pharynx tissue and in receiver fluid, over 60 mins. Results: Flurbiprofen was detected in receiver fluid from 10 mins following spray application and was quantifiable from 20 mins. Flurbiprofen from lozenge was detected from 10 mins and was above the limit of quantitation in receiver fluid from 40 mins. Flurbiprofen recovered from the surface of the pharynx tissue was 24.45% and 8.48% of applied dose for spray and lozenge, respectively. Flurbiprofen recovered within pharynx tissue was 46.50% and 54.65% of applied dose for spray and lozenge, respectively. For flurbiprofen lozenge, recovery within pharynx tissue was 6-fold higher relative to recovery from the pharynx tissue surface. Conclusion: Flurbiprofen from spray and lozenge formulations penetrated human cadaveric pharynx tissue, indicating that flurbiprofen can reach all layers of the pharynx mucosal tissue, including the underlying lamina propria, which contains blood vessels and nerve fibers that contribute to pain during sore throat. This suggests that flurbiprofen may have a local mechanism of action for sore throat, although this has yet to be determined.

show abstract

Section: Introductionmentioning

confidence: 99%

<p>Determination of the Permeation and Penetration of Flurbiprofen into Cadaveric Human Pharynx Tissue</p>

Turner¹,

Wevrett²,

Edmunds³

et al. 2020

CPAA

View full text Add to dashboard Cite

show abstract

“…There were additional studies ( n = 3) retrieved from the electronic search which reported haemorrhagic events with flurbiprofen (in formulations synonymous with oromucosal spray/lozenge) but at a low dose other than 8.75 mg ( Türk et al, 2018 ; Isler et al, 2018 ; Dionne et al, 2004 ). These did not fulfil the eligibility criteria for the systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…Where additional haemorrhagic events were identified with low doses of flurbiprofen, these were observed in patients undergoing oral surgery (e.g., tonsillectomy, palatal graft harvesting surgery, mandibular extraction) ( Türk et al, 2018 ; Isler et al, 2018 ; Dionne et al, 2004 ). Bleeding events were described as post-operative haemorrhage or delayed bleeding.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Flurbiprofen 8.75 mg Dose and Risk of Haemorrhagic Events

et al. 2021

View full text Add to dashboard Cite

Oral non-steroidal anti-inflammatory drugs (NSAIDs) are known to be associated with an increased risk of bleeding. The NSAID, flurbiprofen, in the form of 8.75 mg lozenge or oromucosal spray is indicated for the symptomatic relief of sore throat. Despite the low dose as compared to alternative flurbiprofen preparations, concerns have been raised regarding its safety in terms of haemorrhagic events. This systematic review was conducted to identify existing evidence on the risk of haemorrhagic events with flurbiprofen 8.75 mg dose (any formulation), particularly where this may be due to potential interactions with other medicinal products. The systematic review examined studies reporting haemorrhagic events in patients receiving flurbiprofen 8.75 mg dose. Six individual electronic databases were searched up to 28th April 2020. Records were initially screened for relevance followed by further review of potentially eligible studies. Data extraction was performed for eligible studies and risk of bias in studies was assessed. The search strategy identified 1093 individual records. Of these, 1038 records were excluded after initial review; the majority of these records related to flurbiprofen in alternative formulations with alternative doses (e.g., eye drops, skin patches, oral tablets) thus were not considered relevant for further review. The 55 remaining records related to flurbiprofen 8.75 mg dose (any formulation) or flurbiprofen lozenge/oromucosal spray where the dose was not specified. After further review, 52 of these records were not considered eligible. Thus, only three records were included in this systematic review. The three studies reported a total of five haemorrhagic events in patients taking flurbiprofen 8.75 mg lozenge; the corresponding risk in each of the studies was 8.33, 1.98 and 1.96%. Where possible, comparison of flurbiprofen 8.75 mg lozenge to placebo produced risk ratios of 0.96 (95% CI 0.07, 13.25) and 2.00 (95% CI 0.10, 118.0). This systematic review found limited evidence on the risk of haemorrhagic events with flurbiprofen when used at a dose of 8.75 mg. Counts were low across all studies and results comparing flurbiprofen and placebo treatment arms were non-significant. However, scarcity of studies and low certainty of evidence for the outcome of haemorrhagic events limits the conclusions of this systematic review.

show abstract

“…The mean decrease of pain score over time was higher in group A + I than that in group A + T [41] . Recently, addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients without notable complications [42] . Muderris et al [43] have also reported that topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications.…”

Section: Nsaidsmentioning

confidence: 99%

Update review of pain control methods of tonsil surgery

et al. 2020

View full text Add to dashboard Cite

The effect of flurbiprofen oral spray and ibuprofen vs ibuprofen alone on postoperative tonsillectomy pain: An open, randomised, controlled trial

Abstract: This study revealed that addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients with no notable complications.

Cited by 5 publications

References 21 publications

<p>Determination of the Permeation and Penetration of Flurbiprofen into Cadaveric Human Pharynx Tissue</p>

<p>Determination of the Permeation and Penetration of Flurbiprofen into Cadaveric Human Pharynx Tissue</p>

A Systematic Review of Flurbiprofen 8.75 mg Dose and Risk of Haemorrhagic Events

Update review of pain control methods of tonsil surgery

Contact Info

Product

Resources

About