Effect Of Flurbiprofen Axetil Combined With Dexmedetomidine On Remifentanyl-induced Hyperalgesia

Research background:Remifentanil has many advantages,such as rapid onset,high efficacy,high controllability,repeated and continuous infusion without accumulation,and so on.It is widely used in clinical practice.However,due to its ultrashort effect,high doses or prolonged use can make the patient produce hyperalgesia.Flurbiprofen axetil and dexmedetomidine are widely used in clinic.Mechanism of the two to prevent hyperalgesia is difficult.We look forward to the synergistic effect of flurbiprofen axetil combined with dexmedetomidine to reduce adverse reactions.Objective:To evaluate the impact and influence of flurbiprofen axetil combined with dexmedetomidine on remifentanil-induced hyperalgesia.Methods:One hundred and twenty patients of ASA?-?undergoing elective thyroidectomy surgery were randomized into 4 groups(n=30): C(compared)? F(flurbiprofen axetil)? D(dexmedetomidine)? F+D(flurbiprofen axetil combined with dexmedetomidine).Preoperative and postoperative 0.5h and 1h were used to measure the pain threshold of patients with Von Frey Hair mechanical stimulation needles.The equal volume of normal saline was given before skin incision in group C.Flurbiprofen axetil 2mg/kg was injected venously 10 min before the induction of anesthesia in group F.Dexmedetomidine of 1?g/kg was pumping uniformly into group D with 30 min at the same time of the induction of anesthesia.Flurbiprofen axetil 1mg/kg was injected venously 10 min before the induction of anesthesia,as well as dexmedetomidine of 0.5?g/kg was pumping uniformly into group F+D with 30 min at the same time of the induction of anesthesia.The surgery was maintained with infusion of remifentanil 0.20 ?g.kg-1.min-1 and propofol 4-12 mg.kg-1.h-1 with Narcotrend 37-64.Remifentanil and propofol were stopped at the end of a surgery.And then,all the patients were sended into PACU.Results:There was no significant difference in age,BMI,sex ratio,ASA,anesthesia time,extubation time and intraoperative hypotension between 4 groups(P > 0.05).Compared with group C,the incidence of skin pain threshold decreased significantly in the F,D and F+D groups(P < 0.05)after 0.5h and 1h;he ratio of nause and vomiting in group F is higher(P < 0.05);the ratio of bradycardia in group D is significant higher(P < 0.05).There was no significant difference in the incidence of skin pain thresholds between the three groups of patients with F,D and F+D after 0.5h and 1h(P > 0.05).The ratio of nause and vomiting in group D+F is lower(P < 0.05)compared with group F.The ratio of bradycardia in group F+D is significant lower compared with group D(P < 0.05).Conclusions:The desine of flurbiprofen axetil 1mg/kg was injected venously 10 min before the induction of anesthesia,as well as dexmedetomidine of 0.5?g /kg was pumping uniformly with 30 min at the same time of the induction of anesthesia is recommended because of the effectiveness in preventing remifentanil-induced hyperalgesia and little side effects.