Preoperative butorphanol and flurbiprofen axetil therapy attenuates remifentanil-induced hyperalgesia after laparoscopic gynaecological surgery: a randomized.

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Preoperative butorphanol and flurbiprofen axetil therapy attenuates remifentanil-induced hyperalgesia after laparoscopic gynaecological surgery: a randomized double-blind controlled trial L Zhang, R Shu, Q Zhao, Y Li, Y Yu, G Wang British Journal of Anaesthesia Volume 117, Issue 4, Pages 504-511 (October 2016) DOI: 10.1093/bja/aew248 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Consolidated Standards of Reporting Trials (CONSORT) flow diagram. British Journal of Anaesthesia 2016 117, 504-511DOI: (10.1093/bja/aew248) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Postoperative sedation levels and pain scores. Sedation levels (a) were assessed using Ramsay scores at 5, 10, 15, 30, and 60 min after arrival at the PACU. The NRS score for pain at rest (b) and after movement (c) was documented at 1, 3, 6, 12, and 24 h after surgery. Group S, normal saline administered i.v. before anaesthesia induction and intraoperative sufentanil therapy 0.30 µg kg−1; Group R, normal saline administered i.v. before induction and intraoperative remifentanil 0.30 µg kg−1 min−1; Group B, intraoperative remifentanil and butorphanol 20 µg kg−1 before induction; and Group BF, intraoperative remifentanil and butorphanol 10 µg kg−1 combined with flurbiprofen axetil 0.5 mg kg−1 before induction. All the patients underwent laparoscopic gynaecological surgery under sevoflurane anaesthesia. Values are presented as the mean (sd). *P<0.05 and **P<0.01 vs Group R. NRS, numerical rating scale; PACU, postanaesthetic care unit. British Journal of Anaesthesia 2016 117, 504-511DOI: (10.1093/bja/aew248) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 Postoperative mechanical pain threshold, normalized area of hyperalgesia, and comfort and satisfaction score. The mechanical pain threshold (a) and normalized area of hyperalgesia (b) were tested before and 24 h after surgery with Von Frey filaments. The postoperative comfort and satisfaction scale (c) was used to record the scores for 24 h after surgery. Group S, normal saline administered i.v. before anaesthesia induction and intraoperative sufentanil therapy 0.30 µg kg−1; Group R, normal saline administered i.v. before induction and intraoperative remifentanil 0.30 µg kg−1 min−1; Group B, intraoperative remifentanil and butorphanol 20 µg kg−1 before induction; and Group BF, intraoperative remifentanil and butorphanol 10 µg kg−1 combined with flurbiprofen axetil 0.5 mg kg−1 before induction. All patients underwent laparoscopic gynaecological surgery under sevoflurane anaesthesia. Values are presented as the mean (sd). *P<0.05 and **P<0.01 vs Group R; ##P<0.01 vs baseline threshold. British Journal of Anaesthesia 2016 117, 504-511DOI: (10.1093/bja/aew248) Copyright © 2016 The Author(s) Terms and Conditions