Sun, M., Liao, Q., Wen, L., Yan, X., Zhang, F., & Ouyang, W. (2013). Effect of perioperative intravenous flurbiprofen axetil on chronic postmastectomy pain. Journal of Central South University. Medical Sciences, 38, 653–660. 

To assess whether perioperative intravenous flurbiprofen axetil reduces postmastectomy pain syndrome

Patients were randomized to receive either 50 mg of flurbiprofen axetil 15 minutes before surgical incisions and six hours after or 5 ml of intralipid as a control. All patients were receiving unilateral breast surgeries and lymph node dissections for breast cancer. All patients received the same anesthesia protocol for postoperative patient-controlled analgesia with fentanyl for 48 hours. Pain and opioid dose were recorded at two, six, 12, 24, and 48 hours after surgery. Chronic pain assessments were done by telephone at two, four, six, and 12 months after surgery.

• N = 60
• MEAN AGE = 49.9 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: All patients received chemotherapy, and none received radiation therapy.

• SITE: Single site  
• SETTING TYPE: Multiple settings  
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

Double-blinded, randomized, controlled trial

• 11-point Numeric Rating Scale (NRS) for pain

About a third of patients had mild to moderate pain two months after surgery with an average score of 0.77. Pain scores at all time points after surgery were lower in the flurbiprofen group (p < 0.02). These differences were most pronounced at two, four, and six months. The incidence of pain also was consistently lower in the flurbiprofen group at all time points and significantly lower at two, four, and six months (p < 0.02).

Perioperative infusion with flurbiprofen axetil was associated with the the reduced incidence and severity of chronic postmastectomy pain during the first year.

• Small sample (< 100)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement validity/reliability questionable
• Other limitations/explanation: The single NRS used for pain measurement was limited. No information was provided about analgesic use during the follow-up period.

Although there were limitations, the results of this study were promising, and it was possible that perioperative flurbiprofen could be beneficial in reducing chronic postmastectomy pain by reducing inflammatory mechanisms. Additional research in this area is warranted.