Study Of Preemptive Analgesia With Flurbiprofen Axetil In Pediatric Tonsillectomy And Adenoidectomy

Objective:To investigate the effects of preemptive analgesia with different doses of flurbiprofen axetil on intraoperative inflammatory response and postoperative emergence agitation during adenotonsillectomy in children.Methods:90 children aged 4-8 years undergoing adenotonsillectomy were randomly divided into three groups of equal size.Flurbiprofen axetil was diluted with normal saline to 5 milliliters in groups B and C.The control group（group A）was intravenously injected with normal saline 5milliliters into 15 minutes before the surgery,1.0 mg·kg^-1 flurbiprofen axetil group（group B）and 1.5 mg·kg^-1 flurbiprofen axetil group（group C）were intravenously injected with 1.0mg·kg^-1 flurbiprofen axetil 5 milliliters and 1.5 mg·kg^-1 flurbiprofen axetil 5 milliliters,respectively.The heart rate and Sp O₂was observed before surgery（T₀）,at the beginning of surgery（T₁）,immediately after surgery（T₂）,immediate tracheal extubation（T₃）,5 minutes after tracheal extubation（T₄）and 15 minutes（T₅）.Peripheral venous blood was collected at T₀ and T₂,the plasma concentration of tumor necrosis factor-α（TNF-α）and interleukin-10（IL-10）were measured using enzyme linked immunosorbent assay.The emergence agitation and pain score was evaluated by pediatric anesthesia emergence delirium（PAED）and the face,legs,activity,cry,consolability,behavioral tool（FLACC）at the following time-points:T₃,T₄ and T₅.Postanesthesia care unit（PACU）duration and postoperative bleeding,bradycardia,nausea and vomiting were observed in each group.Results:1.There was no significant difference in baseline data such as gender,age,height and weight among the three groups（P>0.05）.2.PAED and FLACC score:at T₃,T₄and T₅,the PAED and FLACC scores of group B and C were lower than those of group A,the difference was statistically significant（P<0.05）,and the difference of group C was smaller than that of group B was statistically significant（P<0.05）.3.There was no significant difference in IL-10 concentration among all groups at T₀ and T₂（P>0.05）.At T₀,there was no statistical significance in TNF-αconcentration difference among the three groups（P>0.05）.At T₂,the concentration of TNF-αin group C was148.8（66.6）ng·L^-1,which was significantly lower than the 194.4（81.1）ng·L^-1 difference in group A（P<0.05）,while there was no significant difference between group B and groups A and C（P>0.05）.4.Heart rate and Sp O2:There were no significant differences in heart rate and Sp O2among the three groups at each time point（P>0.05）.5.Time of operation and PACU residence time:the time of operation of group A was（30.2±7.4）minutes,group B was（31.4±6.8）minutes,and group C was（34.1±10.4）minutes,and there was no statistical significance between the three groups（P>0.05）.PACU residence time in group A was（50.0±17.6）minutes,group B was（50.2±14.6）minutes,and group C was（50.6±15.6）minutes.There was no statistical significance in PACU residence time among the three groups（P>0.05）.6.Adverse reactions:Postoperative hemorrhage occurred in 1 case（3.3%）and bradycardia occurred in 1 case（3.3%）in group A.There was no statistical significance in the occurrence of postoperative hemorrhage and bradycardia among the three groups（P>0.05）,and no adverse events such as nausea and vomiting occurred in each group.Conclusion:The preemptive analgesia of flurbiprofen axetil can reduce the occurrence of emergence agitation after adenotonsillectomy in children.The clinical effect of 1.5 mg·kg^-1 flurbiprofen axetil is better than 1.0 mg·kg^-1,and can reduce Intraoperative inflammation response,does not increase adverse reactions.