Preoperative intravenous flurbiprofen reduces postoperative pain and inflammatory cytokines in elderly patients after hip arthroplasty

Abstract

Effect of flurbiprofen on the postoperative cognition and inflammatory cytokines in elderly patients after hip arthroplasty was investigated. Elderly patients undergoing replacement of total hip were randomly divided into three groups of equal size (n=60). A control group (control) received no treatment before or at the end of surgery. The other two groups, PRE and INTRA, received 50 mg flurbiprofen intravenously 15 min before the surgery and 30 min before the end of surgery, respectively. The pain score was evaluated by a visual analog scale (VAS) at the following time-points: 24 h before surgery (T0), and 3 h (T1), 12 h (T2) and 24 h (T3) after surgery. Peripheral venous blood was collected at T0, T1, T2 and T3. Cognitive function was assessed by mini-mental state examination (MMSE) at the time of T0, T1, T2 and T3. The serum concentration of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, and Cox-2 were measured using enzyme linked immunosorbent assay (ELISA). The VAS scores and the release of pro-inflammatory cytokines in the PRE and INTRA groups were less than those in the control group at T1, T2 and T3. The MMSE scores in PRE and INTRA groups were significantly higher than those in the control group at T1, T2 and T3. The PRE group showed a lower VAS score, release of pro-inflammatory cytokines and higher MMSE scores at T1, T2 and T3 than the control and INTRA groups. Intravenous flurbiprofen administration reduces postoperative pain and flammatory response after hip arthroplasty. Moreover, flurbiprofen is more effective when given preoperatively than intraoperatively.

Keywords: flurbiprofen; inflammatory cytokines; postoperative cognitive dysfunction; preoperative analgesia.

Figure 1.

Serum levels of pro-inflammatory cytokines among the three groups (mean ± standard deviation). Serum levels of pro-inflammatory cytokines including TNF-α (A), IL-1β (B), IL-6 (C) and Cox-2 (D) were measured by ELISA. *P<0.05, **P<0.01 vs. control group; ^#P<0.05 vs. INTRA group. TNF-α, tumor necrosis factor α; IL-1β, interleukin-1β; Cox-2, cyclooxygenase-2.