Objective : To determine the effect of flurbiprofen combined with prednisolone on interleukin-6 in elderly surgery patients. Methods: In this double-blind randomized controlled study, patients aged 65 to 80 who were undergoing spinal fusion surgery for disc herniation were administered flurbiprofen 100 mg (P group , flurbiprofen group), prednisolone 0.6 mg/kg (D group, predni solone group), prednisolone 0.6 mg/kg plus flurbiprofen 100 mg (P + D group , flurbiprofen + prednisolone group) or normal saline (S group , saline group) 15 minutes before the induction of anesthesia. Plasma samples were col lected before surgery (T0) and on day 1 (T1), day 2 (T2) and day 3 (T3) fol lowing surgery. At the same time, systemic inflammatory response syndrome (SIRS) was assessed by SIRS criteria. The levels of interleukin-6 (IL-6), tumor necrosis factor- α (TNF- α ) and C-reactive protein (CRP) for collected samples were measured. Results: Other groups had significantly lower levels of IL-6, CRP and occurrence of SIRS than S group ( p < 0.05). Compared to groups P and D, the levels of IL-6 and CRP in P + D group w ere significantly lower on T1 ( p < 0.05). Peak levels of IL-6 in all groups were presented on T1 ( p < 0.05). The levels of CRP within three days were significantly different but did not show peak levels ( p > 0.05). Conclusion : Compared to prednisolone or flurbiprofen, combining flurbiprofen with prednisolone in elderly surgery patients led to an increased suppression of IL-6.
KeywordsSIRSSystemic Inflammatory Response SyndromeIL-6Interleukin-6CRPC-Reactive Protein
Zeng, Y. (2012) Toward Deeper Research and Better Policy for Healthy Aging—Using the Unique Data of Chinese Longitudinal Healthy Longevity Survey. China Economic Journal, 5, 131-149. https://doi.org/10.1080/17538963.2013.764677
Ceccarelli, G., Andolfi, E., Biancafarina, A., et al. (2017) Robot-Assisted Surgery in Elderly and Very Elderly Population: Our Experience in Oncologic and General Surgery with Literature Review. Aging Clinical & Experimental Research, 29, 55-63. https://doi.org/10.1007/s40520-016-0676-5
Koo, E.G.Y., Lai, L.M.L., Choi, G.Y.S., et al. (2011) Systemic Inflammation in the Elderly. Best Practice & Research Clinical Anaesthesiology, 25, 413-425. https://doi.org/10.1016/j.bpa.2011.06.005
Call, T.R., Pace, N.L., Thorup, D.B., et al. (2015) Factors Associated with Improved Survival after Resection of Pancreatic Adenocarcinoma. Anesthesiology, 122, 317-324. https://doi.org/10.1097/ALN.0000000000000489
Barnes, P.J. (2016) Glucocorticosteroids. In: Page, C. and Barnes, P., Eds., Pharmacology and Therapeutics of Asthma and COPD, Handbook of Experimental Pharmacology, Vol. 237, Springer, Cham, 93-115. https://doi.org/10.1007/164_2016_62
Sauerland, S. (2000) Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients: A Systematic Review. Drug Safety, 23, 449-461. https://doi.org/10.2165/00002018-200023050-00007
None (2017) Dexamethasone versus Standard Treatment for Postoperative Nausea and Vomiting in Gastrointestinal Surgery: Randomised Controlled Trial (DREAMS Trial). BMJ, 357, j1455. https://doi.org/10.1136/bmj.j1455
Yin, Y., Yi, Y., Yu, J., et al. (2017) Effects of Flurbiprofen on Serum Level of Interleukin-6, Prostacyclin and Corticosteroid A2 in Patients with Bone Metastases of Cancer. Oncology Letters, 15, 1545-1548. https://doi.org/10.3892/ol.2017.7482
Cai, Z.Y. and Yan, Y. (2007) Pathway and Mechanism of Oxidative Stress in Alzheimer’s Disease. Journal of Medical Colleges of PLA, 22, 320-324, ibc-1. https://doi.org/10.1016/S1000-1948(07)60064-1
Comstedt, P., Storgaard, M. and Lassen, A.T. (2009) The Systemic Inflammatory Response Syndrome (SIRS) in Acutely Hospitalised Medical Patients: A Cohort Study. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 17, Article No. 67. https://doi.org/10.1186/1757-7241-17-67
Bancos, S., Bernard, M.P., Topham, D.J., et al. (2009) Ibuprofen and Other Widely Used Non-Steroidal Anti-Inflammatory Drugs Inhibit Antibody Production in Human Cells. Cellular Immunology, 258, 18-28. https://doi.org/10.1016/j.cellimm.2009.03.007
Shimizu, C., Kubo, M., Takano, K., et al. (2001) Interleukin-6 (IL-6) Producing Phaeochromocytoma: Direct IL-6 Suppression by Non-Steroidal Anti-Inflammatory Drugs. Clinical Endocrinology, 54, 405-410. https://doi.org/10.1046/j.1365-2265.2001.01082.x
Bianchi, M., Broggini, M., Balzarini, P., et al. (2006) Effects of Nimesulide on Pain and on Synovial Fluid Concentrations of Substance P, Interleukin-6 and Interleukin-8 in Patients with Knee Osteoarthritis: Comparison with Celecoxib. International Journal of Clinical Practice, 61, 1270-1277. https://doi.org/10.1111/j.1742-1241.2007.01453.x
Schumacher, H.R., Meng, Z., Sieck, M., et al. (1996) Effect of a Nonsteroidal Anti-Inflammatory Drug on Synovial Fluid in Osteoarthritis. The Journal of Rheumatology, 23, 1774-1777.
Gallelli, L., et al. (2013) The Effects of Nonsteroidal Anti-Inflammatory Drugs on Clinical Outcomes, Synovial Fluid Cytokine Concentration and Signal Transduction Pathways in Knee Osteoarthritis. A Randomized Open Label Trial. Osteoarthritis and Cartilage, 21, 1400-1408.
Nagai, H. (1999) Interleukin-1beta Induces Interleukin-6 Production through the Production of Prostaglandin E2 in Human Osteoblasts, MG-63 Cells. Journal of Biochemistry, 126, 553-558. https://doi.org/10.1093/oxfordjournals.jbchem.a022485
Muroi, C., Hugelshofer, M., Seule, M., et al. (2014) The Impact of Nonsteroidal Anti-Inflammatory Drugs on Inflammatory Response after Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 20, 240-246. https://doi.org/10.1007/s12028-013-9930-2
Dittrich, A., et al. (2012) Glucocorticoids Increase Interleukin-6-Dependent Gene Induction by Interfering with the Expression of the Suppressor of Cytokine Signaling 3 Feedback Inhibitor. Hepatology, 55, 256-266. https://doi.org/10.1002/hep.24655
Gao, Q., Mok, H.P., Wang, W.P., Zuo, X.-F. and Chen, L.Q. (2014) Effect of Perioperative Glucocorticoid Administration on Postoperative Complications Following Esophagectomy: A Meta-Analysis. Oncology Letters, 7, 349-356. https://doi.org/10.3892/ol.2013.1748
Mogensen, T.H., Berg, R.S., et al. (2008) Mechanisms of Dexamethasone-Mediated Inhibition of Toll-Like Receptor Signaling Induced by Neisseria meningitidis and Streptococcus pneumoniae. Infection & Immunity, 76, 189-197. https://doi.org/10.1128/IAI.00856-07
Cunningham, C. and Skelly, D.T. (2012) Non-Steroidal Anti-Inflammatory Drugs and Cognitive Function: Are Prostaglandins at the Heart of Cognitive Impairment in Dementia and Delirium? Journal of Neuroimmune Pharmacology, 7, 60-73. https://doi.org/10.1007/s11481-011-9312-5
Lu, J., Chen, G., Zhou, H., et al. (2017) Effect of Parecoxib Sodium Pretreatment Combined with Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients after Shoulder Arthroscopy: A Randomized Double Blinded Controlled Trial. Journal of Clinical Anesthesia, 41, 30-34. https://doi.org/10.1016/j.jclinane.2017.06.004
Rettig, T.C.D., Verwijmeren, L., Dijkstra, I.M., et al. (2016) Postoperative Interleukin-6 Level and Early Detection of Complications after Elective Major Abdominal Surgery. Annals of Surgery, 263, 1207-1212. https://doi.org/10.1097/SLA.0000000000001342
Tsujimoto, H., Ono, S., Takahata, R., et al. (2012) Systemic Inflammatory Response Syndrome as a Predictor of Anastomotic Leakage after Esophagectomy. Surgery Today, 42, 141-146. https://doi.org/10.1007/s00595-011-0049-9
Warschkow, R., Beutner, U., Steffen, T., et al. (2012) Safe and Early Discharge after Colorectal Surgery Due to C-Reactive Protein. Annals of Surgery, 256, 245-250. https://doi.org/10.1097/SLA.0b013e31825b60f0
Yamauchi, H., Kobayashi, E., Yoshida, T., et al. (1998) Changes in Immune-Endocrine Response after Surgery. Cytokine, 10, 549-554. https://doi.org/10.1006/cyto.1997.0322
Brealey, D., Brand, M., Hargreaves, I., et al. (2002) Association between Mitochondrial Dysfunction and Severity and Outcome of Septic Shock. The Lancet, 360, 219-223. https://doi.org/10.1016/S0140-6736(02)09459-X