Effect of preoperative flupirtine on postoperative morphine sparing in patients undergoing total abdominal hysterectomy

Abstract

Background:Flupirtine is a unique non-opioid, centrally acting analgesic with muscle relaxant properties. So far no study has evaluated, use of preoperative flupirtine on postoperative morphine sparing effect in patients undergoing total abdominal hysterectomy (TAH).Materials and Methods:We performed a prospective, controlled, and randomized study in 50 female patients of American Society of Anesthesiologists physical status I–II, aged between 30 and 60 years scheduled for TAH under general anesthesia (GA). Patients were randomized to receive either single dose flupirtine 100 mg or placebo 1 h prior to surgery. A standard anesthetic and analgesic protocol was followed in both the groups. Postoperatively, a titrated loading dose of intravenous morphine 0.1 mg/kg was followed with patient-controlled analgesia with morphine (bolus of 0.01 mg/kg with a lockout time of 7 min). The primary outcome was cumulative morphine consumption at 48 h postoperatively. Secondary outcomes included hemodynamics, visual analog scale (VAS) at rest, VAS on cough, and any adverse effects.Results:All enrolled 50 patients completed the follow-up. The cumulative mean morphine consumption (standard deviation [SD]) at 48 h (40.4 [6.0] vs. 47 [6.6] mg, P = 0.001) was reduced in-group flupirtine as compared with placebo. The cumulative mean VAS at rest (SD) (3 [0.7] vs. 3.7 [0.7], P = 0.001) and on cough (3 [0.9] vs. 3.8 [0.5], P = 0.002) were reduced in-group flupirtine as compared with placebo at 48 h postoperatively.Conclusion:Preoperative use of flupirtine exhibited morphine sparing effect in patients following TAH under GA at 48 h.

Efficacy of flupirtine for postoperative pain: A systematic review and meta-analysis

“…[ 8 ] Only in two studies a single dose of flupirtine was given. [ 8 , 11 ] The rest of the studies repeated flupirtine doses for pain relief for 1–5 days. The interval between two doses of flupirtine varied between 4 and 24 hours.…”

A comparative study of efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery

“…This observation partly correlates with the findings of another study, 10 indicating that though both the study drugs have a slight delay in onset, they have a longer duration of analgesia. Flupirtine used as preemptive analgesic in laparoscopic cholecystectomy surgery had provided adequate pain relief postoperatively in a study conducted by Yadav et al 11 and in postabdominal hysterectomy study conducted by Thapa et al 12 These studies indicate that preemptive use of flupirtine could provide immediate postoperative pain relief; hence, administering this drug preemptively followed by postoperative dosing may be a better method for postoperative analgesia in orthopedic surgeries.…”

Evaluation of preoperative flupirtine in ambulatory functional endoscopic sinus surgery: A prospective, double-blind, randomized controlled trial

“…Similarly, Thapa et al . [ 27 ] found significant difference in sedation score in flupirtine (100 mg) group, but the awakening was same in both the groups. Here, we also have found that sedation was quite comparable in both the groups, and proportionately, slight delay was seen in PACU recovery and hospital discharge in flupirtine-treated group, but the results were statistically insignificant.…”

“…We have found that fentanyl requirement both in terms of number and the total dosage was significantly less in the flupirtine-treated Group (F) than placebo (C). Similarly, analgesic consumption as morphine requirement was significantly lower in flupirtine-treated group was also observed by Thapa et al .,[ 27 ] with P = 0.009, 0.004, 0.002 at 2, 4, 6 h, respectivel, y in the postoperative period. Ahuja et al .…”

“…On the contrary, with similar dosing of flupirtine, Thapa et al . [ 27 ] found that easily arousable sedation was significantly higher in test group.…”