Effect of Multimodal Preemptive Analgesia of Flurbiprofen Axetil, Nalbuphine, and Retrobulbar Block on Postoperative Pain and Enhanced Recovery in Patients Undergoing Oculoplastic Day Surgery: A Prospective, Randomized, Double-Blinded Study

Abstract

Purpose:To evaluate the effect of either flurbiprofen axetil or nalbuphine combined with retrobulbar block (RB) before surgery on postoperative pain control and enhanced recovery in day-care patients undergoing orbital implantation.Methods: A total of 45 patients undergoing orbital implantation with general anesthesia were randomly divided into three groups: flurbiprofen axetil (1 mg/kg) combined with RB (group F), nalbuphine (0.1 mg/kg) combined with RB (group N), and placebo as normal saline with RB (group C). The primary outcome was the average pain score (numeric rating scale: 0-10) within the first 24 hours. Other outcomes including the peak pain score, paracetamol requirement, quality of recovery (QoR)-15, and adverse effects (AEs) were assessed.Results: The average and peak pain scores within 24 hours after surgery in group F were significantly lower than in other groups (p < 0.0167). Compared with group C, the NRS scores were significantly decreased at 2 and 4 hours in group F, and 2 hours in group N after surgery (p < 0.0167), but without significant differences at other measured time points. The time to first paracetamol oral intake displayed a significant difference among the three groups (p < 0.0167).Conclusion: Preemptive use of flurbiprofen axetil 1 mg/ kg combined with RB is an optimal choice for multimodal analgesia for day-care patients undergoing orbital implantation in terms of efficient acute pain control, without impeding patient-enhanced recovery.

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians

“…The preemptive administration of NSAIDs and acetaminophen is essential to ERAS protocols [ 68 ▪ , 69 ▪▪ ]. These medications provide preemptive analgesia by reducing inflammation and offering analgesic and anti-inflammatory effects.…”

Re: “Effect of Multimodal Preemptive Analgesia of Flurbiprofen Axetil, Nalbuphine, and Retrobulbar Block on Postoperative Pain and Enhanced Recovery in Patients Undergoing Oculoplastic Day Surgery: A Prospective, Randomized, Double-Blinded Study”

“…To the Editor: Lower eyelid fullness (baggy eyelids) is caused by orbital fat herniating into the lower lids. 1 At times, this is associated with hollowing beneath the fat (eyelid circles) or a depression medially (nasojugal furrows).…”

“…First, the sample size was calculated based on the findings of their pilot study including 15 patients, in which average numeric rating scale (NRS) scores of pain within the first 24 hours postoperatively were 2.3 ± 0.2, 2.7 ± 0.4 and 3.2 ± 0.5 in Group F, Group N, and Group C, respectively. 1 However, the authors did not specify what effect size, that is, the minimum clinically important difference of postoperative pain NRS score, was clinically significant. This may result in an unbecoming interpretation of their findings that is only based on statistically significant differences rather than clinically significant differences in pain outcomes.…”

“…

In a prospective, randomized, double-blinded study including 45 patients who underwent orbital implantation with general anesthesia, Ye et al 1 compared the effects of adding flurbiprofen axetil and nalbuphine to the retrobulbar block before surgery on postoperative pain control and quality of recovery and showed that flurbiprofen axetil was superior to nalbuphine as a component of the multimodal analgesia regimen. This study has potentially clinical implications, but we had 2 questions about the design and results of this study and wished to get the authors' responses.First, the sample size was calculated based on the findings of their pilot study including 15 patients, in which average numeric rating scale (NRS) scores of pain within the first 24 hours postoperatively were 2.3 ± 0.2, 2.7 ± 0.4 and 3.2 ± 0.5 in Group F, Group N, and Group C, respectively.

…”

“…In a prospective, randomized, double-blinded study including 45 patients who underwent orbital implantation with general anesthesia, Ye et al 1 compared the effects of adding flurbiprofen axetil and nalbuphine to the retrobulbar block before surgery on postoperative pain control and quality of recovery and showed that flurbiprofen axetil was superior to nalbuphine as a component of the multimodal analgesia regimen. This study has potentially clinical implications, but we had 2 questions about the design and results of this study and wished to get the authors' responses.…”