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Efficacy and safety of flurbiprofen axetil in the prevention of pain on propofol injection: A systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Pain on injection is an acknowledged adverse effect (AE) of propofol administration for the induction of general anesthesia. Flurbiprofen axetil has been reported to reduce the pain of injection. However, results of published papers on the efficacy of flurbiprofen axetil in managing pain on injection of propofol are inconsistent. MATERIAL/METHODS: We conducted a comprehensive meta-analysis of studies to appraise the efficacy and safety of flurbiprofen axetil for controlling pain induced by propofol injection. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed- or random-effects models, depending upon the heterogeneity of the included trials. RESULTS: Compared with the placebo group, flurbiprofen axetil allows more patients to have no pain (RR 3.51, 95% CI 2.22-5.55, p=0.000), and decreases the cumulative number of patients with mild, moderate, and severe pain on injecting propofol (RR 0.70, 95% CI 0.58-0.86, p=0.000; RR 0.59, 95% CI 0.46-0.75, p=0.000; RR 0.25, 95% CI 0.16-0.38, p=0.000, respectively). In the stratified analysis by the doses, flurbiprofen axetil at a dose of over 50 mg was found to be effective in reducing propofol-induced pain on injection; however, there were no significant differences in relieving pain between treatment and placebo groups with flurbiprofen axetil at a dose of 25 mg. In terms of drug safety, there were no adverse effects (AEs) reported between flurbiprofen axetil-based regimens and placebo regimens. CONCLUSIONS: Flurbiprofen axetil, an injectable prodrug of flurbiprofen, can significantly prevent or relieve the pain induced by propofol injection. More studies are required to assess its adverse effects.
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A previous interrupted time-series analysis has shown that retraction reduces the number of citations of RCTs.
“Although a previous interrupted time-series analysis has shown that retraction does reduce the number of citations of RCTs [27], the present results indicate that inappropriate citations still prevail.”
From Retracted randomized controlled trials were cited and not corrected in systematic reviews and clinical practice guidelines (2022) · cites this paper as [27]
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Cites
5 retracted
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“at 1 of 3 doses (25, 50, or 75 mg), or vehicle, preceded by manual venous occlusion, for reducing propofol-induced pain on injection, and found that FA (50 or 75 mg) significantly reduced pain intensity compared with vehicle; however, the efficacy was not found with the 25 mg dose [10].”
MethodRetractedFujii, Y., & Itakura, M. (2009) · Clinical Therapeutics · doi:10.1016/j.clinthera.2009.04.014 · Cited by 18 · cited 1×
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BackgroundRetractedMeasuring inconsistency in meta-analyses
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Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain.
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Effectiveness of Different Doses of Tenoxicam in Preventing Propofol Injection Pain
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“(24) have reported that flurbiprofen axetil was not effective in preventing PIP, another comprehensive meta-analysis (18) reported that it was.”
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Management of Propofol Infusion Pain: An Easy Task for Anesthetists
Ismail, M. I. A., Al-Husinat, L., Mar'ey, O., Obeidat, A., Bakkar, A., Manasrah, Q., & Ismail, I. M. I. (2026) · Anesthesiology Research and Practice · doi:10.1155/anrp/9950452
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Metadata
- Authors
- Bao, H.
- Affiliations
- Nanjing First Hospital (CN)
- Corresponding author
- Bao, Hongguang
- ORCID
- Bao, Hongguang
- Venue
- Medical Science Monitor
- Published
- 2014
- Volume
- 20
- Pages
- 995-1002
- ISSN
- 1234-1010 (ISSN-L)
- 1643-3750
- PMC
- PMC4070992
- OpenAlex
- W2166860228
- Cited by
- 33
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 1 · 2018: 1 · 2017: 3 · 2015: 5 · 2014: 1
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Science Monitor (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Health Sciences › Veterinary › Small Animals › Veterinary Pharmacology and Anesthesia
- Keywords
- flurbiprofen axetil, propofol injection pain, general anesthesia induction, analgesia, drug safety, dose-response relationship, nonsteroidal anti-inflammatory drugs
- MeSH terms
- Clinical Trials as Topic, Flurbiprofen, Humans, Pain, Risk Factors, Propofol, Treatment Outcome, Publication Bias
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