Effects of flurbiprofen on cellular immune function during patient-controlled intravenous analgesia with fentanyl in patients after esophagectomy

Abstract

Objective To investigate the effects of flurbiprofen on cellular immune function during patient-controlled intravenous analgesia (PCIA) with fentanyl in the patients after esophagectomy. Methods Forty-five ASA Ⅰ or Ⅱ patients, aged 40-64 yr, weighing 50-80 kg, were randomly divided into 3 groups with 15 cases each: group Ⅰ PCIA with fentanyl 20 μg/kg; group Ⅱ PCIA with fentanyl 10 μg/kg + flurbiprofen 2 mg/kg and group Ⅲ preemptive analgesia with iv flurbiprofen 1 mg/kg + PCIA with fentanyl 10 μg/kg + flurbiprofen 1 mg/kg. The patients received iv injection of fentanyl 0.05 mg 10 min before the end of operation and then were attached to a PCIA pump. Droperidol 2.5 mg was added to normal saline 100 ml in all groups. PCIA was started with background infusion rate 2 ml/h, bolus dose 0.5 ml, lockout interval 5 min. Blood samples were obtained from peripheral vein at 30 min before operation (T0, baseline), and at 1, 24 and 72 h after operation (T1-3) for determination of the plasma concentrations of norepinephrine (NE), adrenocorticotropic hormone (ACTH), cortisol (Cor) and levels of CD3+, CD4+ and CD8+ in lymphocyte. CD4+/CD8+ ratio was calculated. The number of successful delivered doses was recorded. Results The number of successful delivered doses was significantly less in group Ⅲ than in group Ⅰ and Ⅱ (P 0.05). The plasma concentration of ACTH was significantly lower and CD3+ level significantly higher after operation in group Ⅱ , the plasma concentrations of NE, ACTH and Cor were significantly lower, CD3+ level was significantly higher at T1,3, and CD4+ level and CD4+/CD8+ ratio at T1,2 were significantly higher after operation in group Ⅲ than in group Ⅰ (P<0.05). The plasma concentration of NE was significantly lower, and CD4+ level and CD4+/CD8+ ratio were significantly higher in group Ⅲ than in group Ⅱ (P<0.05). Conclusion Flurbiprofen can improve the cellular immune function in the patients after esophagectomy through reducing the consumption of fentanyl for PCIA and inhibiting the postoperative stress, and the efficacy is better when flurbiprofen is used before and after operation. Key words: Flurbiprofen; Fentanyl; Analgesia, patient-controlled; Immunity, cellular