Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery: A Randomized, Controlled, Double-Blinded Trial

Yu Mao, Yuanyuan Cao, Bin Mei, Lijian Chen, Xuesheng Liu, Zhi Zhang, Erwei Gu, Yu Mao, Yuanyuan Cao, Bin Mei, Lijian Chen, Xuesheng Liu, Zhi Zhang, Erwei Gu

Abstract

Objective: To assess different doses of nalbuphine with flurbiprofen compared to sufentanil with flurbiprofen in multimodal analgesia efficacy for elderly patients undergoing gastrointestinal surgery with a transverse abdominis plane block (TAPB).

Methods: 158 elderly patients scheduling for elective open gastrointestinal surgery under general anesthesia and TAPB were randomly assigned to four groups according to different doses of nalbuphine with flurbiprofen in postoperative intravenous analgesia (PCIA). Postoperative pain intensity, effective pressing numbers of PCIA, and adverse effects were recorded at 6, 12, 24, and 48 hours after surgery.

Results: Postoperative pain intensity, effective pressing numbers, and the incidence of postoperative nausea and vomiting (PONV) were similar among the four groups after surgery, while the severity of PONV was decreased in Group L compared with Group S at 6, 12, and 48 h after surgery. No individual experienced pruritus, respiratory depression, or hypotension.

Conclusions: Low dose of nalbuphine (15 μg·kg-1·ml-1) combined with flurbiprofen is superior for elderly patients undergoing elective open gastrointestinal surgery with TAPB in terms of the efficient postoperative analgesia and decreased severity of PONV. This trial is registered with NCT02984865.

Figures

Figure 1
Figure 1
Flow of patients in the study.

References

    1. Massarweh N. N., Legner V. J., Symons R. G., McCormick W. C., Flum D. R. Impact of advancing age on abdominal surgical outcomes. Archives of Surgery. 2009;144(12):1108–1114. doi: 10.1001/archsurg.2009.204.
    1. Filos K. S., Lehmann K. A. Current concepts and practice in postoperative pain management: need for a change? European Surgical Research. 1999;31(2):97–107. doi: 10.1159/000008627.
    1. Van de Ven T. J., Hsia H. L. J. Causes and prevention of chronic postsurgical pain. Current Opinion in Critical Care. 2012;18(4):366–371. doi: 10.1097/MCC.0b013e3283557a7f.
    1. Hingula L., Maslin B., Rao S., et al. Perioperative pain control in gastrointestinal surgery. Middle East Journal of Anaesthesiology. 2015;23(2):137–146.
    1. Akshat S., Ramachandran R., Rewari V., Chandralekha, Trikha A., Sinha R. Morphine versus nalbuphine for open gynaecological surgery: a randomized controlled double blinded trial. Pain Research and Treatment. 2014;2014:6. doi: 10.1155/2014/727952.727952
    1. Stoelting R. K., Weinger M. B. Dangers of postoperative opioids: is there a cure? Bulletin of the American College of Surgeons. 2010;95(2):21–22.
    1. Freye E., Levy J. V. Use of opioids in the elderly–pharmacokinetic and pharmacodynamic considerations. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS. 2004;39:527–537. doi: 10.1055/s-2004-825883.
    1. Davis M. P. Drug management of visceral pain: concepts from basic research. Pain Research and Treatment. 2012;2012:18. doi: 10.1155/2012/265605.265605
    1. Zeng Z., Lu J., Shu C., et al. A comparision of nalbuphine with morphine for analgesic effects and safety : meta-analysis of randomized controlled trials. Scientific Reports. 2015;5(1):p. 10927. doi: 10.1038/srep10927.
    1. Schumann R., Shikora S., Weiss J. M., Wurm H., Strassels S., Carr D. B. A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesthesia & Analgesia. 2003;96(2):469–474. doi: 10.1097/00000539-200302000-00032.
    1. Gupta A., Bah M. NSAIDs in the treatment of postoperative pain. Current Pain and Headache Reports. 2016;20(11):p. 62. doi: 10.1007/s11916-016-0591-7.
    1. Geng W., Hong W., Wang J., et al. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates postoperative emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery. Mediators of Inflammation. 2015;2015:6. doi: 10.1155/2015/601083.601083
    1. Lissauer J., Mancuso K., Merritt C., Prabhakar A., Kaye A. D., Urman R. D. Evolution of the transversus abdominis plane block and its role in postoperative analgesia. Best Practice & Research Clinical Anaesthesiology. 2014;28(2):117–126. doi: 10.1016/j.bpa.2014.04.001.
    1. Kartalov A., Jankulovski N., Kuzmanovska B., et al. Effect of adding dexamethasone as a ropivacaine adjuvant in ultrasound-guided transversus abdominis plane block for inguinal hernia repair. Prilozi (Makedonska akademija na naukite i umetnostite Oddelenie za medicinski nauki) 2015;36(3):35–41. doi: 10.1515/prilozi-2015-0076.
    1. Garimella V., Cellini C. Postoperative pain control. Clinics in Colon and Rectal Surgery. 2013;26(3):191–196. doi: 10.1055/s-0033-1351138.
    1. Moher D., Hopewell S., Schulz K. F., et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. International Journal of Surgery. 2012;10(1):28–55. doi: 10.1016/j.ijsu.2011.10.001.
    1. Schulz K. F., Altman D. G., Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. International Journal of Surgery. 2011;9(8):672–677. doi: 10.1016/j.ijsu.2011.09.004.
    1. Taylor R., Jr., Pergolizzi J. V., Sinclair A., et al. Transversus abdominis block: clinical uses, side effects, and future perspectives. Pain Practice. 2013;13(4):332–344. doi: 10.1111/j.1533-2500.2012.00595.x.
    1. Gustafsson U. O., Scott M. J., Schwenk W., et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clinical Nutrition. 2012;31(6):783–800. doi: 10.1016/j.clnu.2012.08.013.
    1. Nygren J., Thacker J., Carli F., et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clinical Nutrition. 2012;31(6):801–816. doi: 10.1016/j.clnu.2012.08.012.
    1. Hansdottir V., Philip J., Olsen M. F., Eduard C., Houltz E., Ricksten S. E. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology. 2006;104(1):142–151.
    1. Ding X., Jin S., Niu X., Ren H., Fu S., Li Q. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis. PloS One. 2014;9(5) doi: 10.1371/journal.pone.0096233.e96233
    1. Kupersztych-Hagege E., Dubuisson E., Szekely B., et al. Epidural hematoma and abscess related to thoracic epidural analgesia: a single-center study of 2,907 patients who underwent lung surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(2):446–452. doi: 10.1053/j.jvca.2016.07.022.
    1. Borzellino G., Francis N. K., Chapuis O., Krastinova E., Dyevre V., Genna M. Role of epidural analgesia within an ERAS program after laparoscopic colorectal surgery: a review and meta-analysis of randomised controlled studies. Surgery Research and Practice. 2016;2016:9. doi: 10.1155/2016/7543684.7543684
    1. El Abdein Mohamed A. Z. Assessment of the analgesic potency of ropivacaine 0.2% versus ropivacaine 0.5% in transversus abdominis plane block after cesarean delivery. Egyptian Journal of Anaesthesia. 2016;32(3):385–390. doi: 10.1016/j.egja.2016.03.003.
    1. Henshaw D. S., Baker M. L., Weller R. S., Reynolds J. W., Jaffe J. D. Transversus abdominis plane block as the primary anesthetic for peritoneal dialysis catheter surgery. Journal of Clinical Anesthesia. 2016;31:182–188. doi: 10.1016/j.jclinane.2016.01.028.
    1. Abdelsalam K., Mohamdin O. W. Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: a randomized controlled study. Saudi Journal of Anaesthesia. 2016;10(1):25–28. doi: 10.4103/1658-354x.169470.
    1. Yu N., Long X., Lujan-Hernandez J. R., Succar J., Xin X., Wang X. Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiology. 2014;14(1):p. 121. doi: 10.1186/1471-2253-14-121.
    1. Finnerty O., Sharkey A., Mc Donnell J. G. Transversus abdominis plane block for abdominal surgery. Minerva Anestesiologica. 2013;79(4):1415–1422. doi: 10.1007/s40140-013-0034-5.
    1. Halaszynski T. M. Ultrasound brachial plexus anesthesia and analgesia for upper extremity surgery: essentials of our current understanding. Current Opinion in Anaesthesiology. 2011;24(5):581–591. doi: 10.1097/aco.0b013e32834aca03.
    1. Albrecht E., Kern C., Kirkham K. R. A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks. Anaesthesia. 2015;70(1):71–83. doi: 10.1111/anae.12823.
    1. Griffiths J. D., Le N. V., Grant S., Bjorksten A., Hebbard P., Royse C. Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section. British Journal of Anaesthesia. 2013;110(6):996–1000. doi: 10.1093/bja/aet015.
    1. Abdallah F. W., Chan V. W., Brull R. Transversus abdominis plane block: a systematic review. Regional Anesthesia and Pain Medicine. 2012;37(2):193–209. doi: 10.1097/aap.0b013e3182429531.
    1. Golan D. E. Priciples of Pharmacology: The Pathophysiologic Basis of Drug Therapy. Baltimore, MD, USA: Lippincott Williams &Wilkins; 2008.
    1. Sinatra R. Role of COX-2 inhibitors in the evolution of acute pain management. Journal of Pain and Symptom Management. 2002;24(1):S18–S27. doi: 10.1016/s0885-3924(02)00410-4.
    1. Yamashita K., Fukusaki M., Ando Y., et al. Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery. Journal of Anesthesia. 2006;20(2):92–95. doi: 10.1007/s00540-006-0389-6.
    1. Bitot V., Beaussier M. NSAIDs and risk of anastomotic leakage after gastrointestinal surgery. Presse Medicale. 2014;43:633–636. doi: 10.1016/j.lpm.2013.09.017.
    1. Klein M. Postoperative non-steroidal anti-inflammatory drugs and colorectal anastomotic leakage. NSAIDs and anastomotic leakage. Danish Medical Journal. 2012;59(3):p. B4420.
    1. Bhangu A., Singh P., Fitzgerald J. E., Slesser A., Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World Journal of Surgery. 2014;38(9):2247–2257. doi: 10.1007/s00268-014-2531-1.
    1. Mihara R., Soen M., Kusaka H., et al. Effect of continuous intravenous infusion of flurbiprofen axetil and tramadol hydrochloride for postoperative pain management of laparoscopic colectomy. Masui the Japanese Journal of Anesthesiology. 2011;60:1364–1369.
    1. Ellmauer S. Sufentanil. An alternative to fentanyl/alfentanil? Der Anaesthesist. 1994;43(3):143–158. doi: 10.1007/s001010050043.
    1. Chen J. C., Smith E. R., Cahill M., Cohen R., Fishman J. B. The opioid receptor binding of dezocine, morphine, fentanyl, butorphanol and nalbuphine. Life Sciences. 1993;52(4):389–396. doi: 10.1016/0024-3205(93)90152-s.
    1. Rawal N., Wennhager M. Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia. Acta Anaesthesiologica Scandinavica. 1990;34(3):197–202. doi: 10.1111/j.1399-6576.1990.tb03069.x.
    1. Flacke J. W., Bloor B. C., Kripke B. J., et al. Comparison of morphine, meperidine, fentanyl, and sufentanil in balanced anesthesia: a double-blind study. Anesthesia & Analgesia. 1985;64(9):897–910. doi: 10.1213/00000539-198509000-00009.
    1. Riviere P. J. Peripheral kappa-opioid agonists for visceral pain. British Journal of Pharmacology. 2004;141(8):1331–1334. doi: 10.1038/sj.bjp.0705763.
    1. Gan T. J., Meyer T. A., Apfel C. C., et al. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia. 2007;105(6):1615–1628. doi: 10.1213/01.ane.0000295230.55439.f4.
    1. Jannuzzi R. G. Nalbuphine for treatment of opioid-induced pruritus: a systematic review of literature. Clinical Journal of Pain. 2016;32(1):87–93. doi: 10.1097/AJP.0000000000000211.
    1. Wang J. J., Ho S. T., Tzeng J. I. Comparison of intravenous nalbuphine infusion versus naloxone in the prevention of epidural morphine-related side effects. Regional Anesthesia and Pain Medicine. 1998;23(5):479–484. doi: 10.1097/00115550-199823050-00009.
    1. Miller J. L., Hagemann T. M. Use of pure opioid antagonists for management of opioid-induced pruritus. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists. 2011;68(15):1419–1425. doi: 10.2146/ajhp100475.
    1. Jarzyna D., Jungquist C. R., Pasero C., et al. American society for pain management nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses. 2011;12(3):118.e10–145.e10. doi: 10.1016/j.pmn.2011.06.008.
    1. Herman N. L., Choi K. C., Affleck P. J., et al. Analgesia, pruritus, and ventilation exhibit a dose-response relationship in parturients receiving intrathecal fentanyl during labor. Anesthesia & Analgesia. 1999;89(2):378–383. doi: 10.1097/00000539-199908000-00024.

Source: PubMed

Подписаться