{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:16:32Z","timestamp":1760955392772,"version":"3.40.4"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2012,9,29]],"date-time":"2012-09-29T00:00:00Z","timestamp":1348876800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Post-thymectomy pain in myasthenia gravis (MG) patients can inhibit breathing and coughing. Inappropriate usage of analgesics may exacerbate respiratory inhibition and even cause myasthenic crisis. Flurbiprofen is a non-steroidal anti-inflammatory drug (NSAID) that is commonly used to control moderate postoperative pain and is not associated with respiratory inhibition. We hypothesized that flurbiprofen may provide post-thymectomy pain relief without increasing the risk of complications in MG patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred MG patients underwent extended thymectomy from March 2006 to December 2010 and were randomly allocated to a flurbiprofen group (110 patients, 50 mg intravenous flurbiprofen axetil) or a control group (90 patients, 100 mg intramuscular tramadol) as postoperative analgesia. Visual analog scale (VAS) pain score, heart rate, blood pressure, respiratory rate, pulse oximetry (SpO<jats:sub>2<\/jats:sub>), and adverse effects were recorded before and up to 24 h after drug administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences in the preoperative clinical characteristics of the flurbiprofen and control (tramadol) groups. Both flurbiprofen and tramadol significantly alleviated post-thymectomy pain (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 for both), but patients in flurbiprofen group had significantly lower VAS pain scores at 0.5 h, 2 h, 4 h, and 8 h after surgery (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 for all times). There were no significant post-thymectomy changes of heart rate, respiratory rate, mean arterial blood pressure, or SpO<jats:sub>2<\/jats:sub>in either group at all time points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Post-thymectomy intravenous administration of flurbiprofen axetil provides safe and effective analgesia for MG patients.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1749-8090-7-98","type":"journal-article","created":{"date-parts":[[2012,10,1]],"date-time":"2012-10-01T01:08:11Z","timestamp":1349053691000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Intravenous flurbiprofen for post-thymectomy pain relief in patients with myasthenia gravis"],"prefix":"10.1186","volume":"7","author":[{"given":"Chunhua","family":"Su","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yihua","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiu-Wen","family":"Chou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weibing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianyong","family":"Zou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honghe","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenguang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2012,9,29]]},"reference":[{"key":"617_CR1","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1056\/NEJM199406233302507","volume":"330","author":"DB Drachman","year":"1994","unstructured":"Drachman DB: Myasthenia gravis. N Engl J Med. 1994, 330: 1797-1810. 10.1056\/NEJM199406233302507.","journal-title":"N Engl J Med"},{"key":"617_CR2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1055\/s-2004-829585","volume":"24","author":"BW Hughes","year":"2004","unstructured":"Hughes BW, Moro De Casillas ML, Kaminski HJ: Pathophysiology of myasthenia gravis. Semin Neurol. 2004, 24: 21-30. 10.1055\/s-2004-829585.","journal-title":"Semin Neurol"},{"key":"617_CR3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S1052-3359(25)00575-7","volume":"11","author":"A Masaoka","year":"2001","unstructured":"Masaoka A: Extended trans-sternal thymectomy for myasthenia gravis. Chest Surg Clin N Am. 2001, 11: 369-387.","journal-title":"Chest Surg Clin N Am"},{"key":"617_CR4","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/BF02125618","volume":"4","author":"HJ Oosterhuis","year":"1983","unstructured":"Oosterhuis HJ: Thymectomy in myasthenia gravis. A review. Ital J Neurol Sci. 1983, 4: 399-407. 10.1007\/BF02125618.","journal-title":"Ital J Neurol Sci"},{"key":"617_CR5","first-page":"681","volume":"112","author":"MS Nussbaum","year":"1992","unstructured":"Nussbaum MS, Rosenthal GJ, Samaha FJ, Grinvalsky HT, Quinlan JG, Schmerler M, Fischer JE: Management of myasthenia gravis by extended thymectomy with anterior mediastinal dissection. Surgery. 1992, 112: 681-688.","journal-title":"Surgery"},{"key":"617_CR6","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/0003-4975(94)90993-8","volume":"57","author":"WH Frist","year":"1994","unstructured":"Frist WH, Thirumalai S, Doehring CB, Merrill WH, Stewart JR, Fenichel GM, Bender HW: Thymectomy for the myasthenia gravis patient: factors influencing outcome. Ann Thor Surg. 1994, 57: 334-338. 10.1016\/0003-4975(94)90993-8.","journal-title":"Ann Thor Surg"},{"issue":"2","key":"617_CR7","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/0022-510X(91)90137-V","volume":"105","author":"N Fujii","year":"1991","unstructured":"Fujii N, Itoyama Y, Machi M, Goto I: Analysis of prognostic factors in thymectomized patients with myasthenia gravis: correlation between thymic lymphoid cell subsets and postoperative clinical course. J Neurol Sci. 1991, 105 (2): 143-149. 10.1016\/0022-510X(91)90137-V.","journal-title":"J Neurol Sci"},{"key":"617_CR8","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/S0003-4975(96)00376-1","volume":"62","author":"A Masaoka","year":"1996","unstructured":"Masaoka A, Yamakawa Y, Niwa H, Fukai I, Condo S, Kobayashi M, Fujii Y, Monden Y: Extended thymectomy for myasthenia gravis: a 20 year review. Ann Thor Surg. 1996, 62: 853-859. 10.1016\/S0003-4975(96)00376-1. Sept","journal-title":"Ann Thor Surg"},{"key":"617_CR9","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/0003-4975(96)00202-0","volume":"62","author":"FC Detterbeck","year":"1996","unstructured":"Detterbeck FC, Scott WW, Howard JF, Egan TM, Keagy BA, Starek JK, Mill MR, Wilcox BR: One hundred consecutive thymectomies for myasthenia gravis. Ann Thorac Surg. 1996, 62: 242-245. 10.1016\/0003-4975(96)00202-0.","journal-title":"Ann Thorac Surg"},{"key":"617_CR10","first-page":"2243","volume-title":"General thoracic surgery","author":"MJ Mack","year":"2000","unstructured":"Mack MJ, Scruggs GR: Video-assisted thymectomy. General thoracic surgery. Edited by: Shields T, LoCicero J, Ponn R. 2000, Philadelphia, PA: Lippincott Williams & Wilkins, 2243-2249. 2 Section XXVIII, Chapter 173, 5","edition":"5"},{"key":"617_CR11","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1016\/0003-4975(96)00537-1","volume":"62","author":"TC Mineo","year":"1996","unstructured":"Mineo TC, Pompeo E, Ambrogi V, Sabato AF, Bernardi G, Casciani CU: Adjuvant pneumomediastinum in thoracoscopic thymectomy for myasthenia gravis. Ann Thor Surg. 1996, 62: 1210-1212. 10.1016\/0003-4975(96)00537-1.","journal-title":"Ann Thor Surg"},{"key":"617_CR12","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/S0003-4975(02)03722-0","volume":"74","author":"JB Shrager","year":"2002","unstructured":"Shrager JB, Deeb ME, Mick R, Brinster CJ, Childers HE, Marshall MB, Kucharczuk JC, Galetta SL, Bird SJ, Kaiser LR: Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg. 2002, 74: 320-327. 10.1016\/S0003-4975(02)03722-0.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"617_CR13","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/j.1600-0404.1992.tb05094.x","volume":"86","author":"C Lindberg","year":"1992","unstructured":"Lindberg C, Andersen O, Larsson S, Oden A: Remission rate after thymectomy in myasthenia gravis when the bias of immunosuppressive therapy is eliminated. Acta Neurol Scand. 1992, 86 (3): 323-328. 10.1111\/j.1600-0404.1992.tb05094.x.","journal-title":"Acta Neurol Scand"},{"key":"617_CR14","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/S0022-5223(19)35684-3","volume":"95","author":"A Jaretzki III","year":"1988","unstructured":"Jaretzki A, Penn AS, Younger DS, Wolff M, Olarte MR, Lovelace RE, Rowland LP: \u201cMaximal\u201d thymectomy for myasthenia gravis: results. J Thorac Cardiovasc Surg. 1988, 95: 747-757.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"617_CR15","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1034\/j.1399-6576.2001.450803.x","volume":"45","author":"E Kalso","year":"2001","unstructured":"Kalso E, Mennander S, Tasmuth T, Nilsson E: Chronic post-sternotomy pain. Acta Anaesthesiol Scand. 2001, 45: 935-939. 10.1034\/j.1399-6576.2001.450803.x.","journal-title":"Acta Anaesthesiol Scand"},{"key":"617_CR16","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1034\/j.1399-6576.2001.450804.x","volume":"45","author":"J Meyerson","year":"2001","unstructured":"Meyerson J, Thelin S, Gordh T, Karlsten R: The incidence of chronic post-sternotomy pain after cardiac surgery\u2013a prospective study. Acta Anaesthesiol Scand. 2001, 45: 940-944. 10.1034\/j.1399-6576.2001.450804.x.","journal-title":"Acta Anaesthesiol Scand"},{"key":"617_CR17","first-page":"31","volume":"69","author":"M Abel","year":"2002","unstructured":"Abel M, Eisenkraft JB: Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002, 69: 31-37.","journal-title":"Mt Sinai J Med"},{"key":"617_CR18","first-page":"438","volume":"117","author":"F Ferreti","year":"1987","unstructured":"Ferreti F, Crestan IS, Rudriguez NJ, Tosi C, Martinoli S: Can one use high thoracic epidural analgesia in post operative intensive care of the myasthenia patient following trans sternal thymectomy?. Schweiz Med Woehenschr. 1987, 117: 438-441.","journal-title":"Schweiz Med Woehenschr"},{"key":"617_CR19","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1111\/j.1399-6576.1997.tb04743.x","volume":"41","author":"E Nilsson","year":"1997","unstructured":"Nilsson E, Perttunen K, Kalso E: Intrathecal morphine for post-sternotomy pain in patients with myasthenia gravis: effects on respiratory function. Acta Anaesthesiol Scand. 1997, 41: 549-556. 10.1111\/j.1399-6576.1997.tb04743.x.","journal-title":"Acta Anaesthesiol Scand"},{"key":"617_CR20","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1007\/BF03012579","volume":"45","author":"D Hopkins","year":"1998","unstructured":"Hopkins D, Shipton EA, Potgieter D, CA VdM, Boon J, De Wet C, Murphy J: Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery. Can J Anaesth. 1998, 45: 435-442. 10.1007\/BF03012579.","journal-title":"Can J Anaesth"},{"key":"617_CR21","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1080\/15360280903098523","volume":"23","author":"S Haroutiunian","year":"2009","unstructured":"Haroutiunian S, Lecht S, Zur AA, Hoffman A, Davidson E: The challenge of pain management in patients with myasthenia gravis. J Pain Palliat Care Pharmacother. 2009, 23: 242-260. 10.1080\/15360280903098523.","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"617_CR22","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1093\/bja\/82.2.221","volume":"82","author":"K Perttunen","year":"1999","unstructured":"Perttunen K, Nilsson E, Kalso E: I.v. diclofenac and ketorolac for pain after thoracoscopic surgery. Br J Anaesth. 1999, 82: 221-227. 10.1093\/bja\/82.2.221.","journal-title":"Br J Anaesth"},{"key":"617_CR23","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1093\/bja\/82.1.56","volume":"82","author":"P Tarkkila","year":"1999","unstructured":"Tarkkila P, Saarnivaara L: Ketoprofen, diclofenac or ketorolac for pain after tonsillectomy in adults?. Br J Anaesth. 1999, 82: 56-60. 10.1093\/bja\/82.1.56.","journal-title":"Br J Anaesth"},{"key":"617_CR24","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/BF03014332","volume":"44","author":"K Mikawa","year":"1997","unstructured":"Mikawa K, Nishina K, Maekawa N, Shiga M, Obara H: Dose\u2013response of flurbiprofen on postoperative pain and emesis after paediatric strabismus surgery. Can J Anaesth. 1997, 44: 95-98. 10.1007\/BF03014332.","journal-title":"Can J Anaesth"},{"key":"617_CR25","doi-asserted-by":"publisher","first-page":"266","DOI":"10.7547\/87507315-80-5-266","volume":"80","author":"ML Ottinger","year":"1990","unstructured":"Ottinger ML, Kinney KW, Black JR, Wittenberg M: Comparison of flurbiprofen and acetaminophen with codeine in postoperative foot pain. J Am Podiatr Med Assoc. 1990, 80: 266-270.","journal-title":"J Am Podiatr Med Assoc"},{"key":"617_CR26","doi-asserted-by":"publisher","first-page":"216","DOI":"10.7150\/ijms.8.216","volume":"8","author":"H Esme","year":"2011","unstructured":"Esme H, Kesli R, Apiliogullari B, Duran FM, Yoldas B: Effects of flurbiprofen on CRP, TNF-\u03b1, IL-6, and postoperative pain of thoracotomy. Int J Med Sci. 2011, 8: 216-221.","journal-title":"Int J Med Sci"},{"key":"617_CR27","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0003-4975(01)02678-9","volume":"72","author":"JM Budde","year":"2001","unstructured":"Budde JM, Morris CD, Gal AA, Manosur KA, Miller JI: Predictor of outcome in thymectomy for myasthenia gravis. Ann Thorac Surg. 2001, 72: 197-202. 10.1016\/S0003-4975(01)02678-9.","journal-title":"Ann Thorac Surg"},{"key":"617_CR28","volume-title":"Myasthenia gravis","author":"KE Osserman","year":"1958","unstructured":"Osserman KE: Myasthenia gravis. 1958, Grune and Stratton: New York"},{"key":"617_CR29","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/00000658-199709000-00012","volume":"226","author":"GB Bulkley","year":"1997","unstructured":"Bulkley GB, Bass KN, Stephenson GR, Diener-West M, George S, Reilly PA, Baker RR, Drachman DB: Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg. 1997, 226: 324-335. 10.1097\/00000658-199709000-00012.","journal-title":"Ann Surg"},{"key":"617_CR30","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/S1052-3359(25)00373-4","volume":"8","author":"G Massard","year":"1998","unstructured":"Massard G, Wihlm JM: Postoperative atelectasis. Chest Surg Clin N Am. 1998, 8: 503-528. viii","journal-title":"Chest Surg Clin N Am"},{"key":"617_CR31","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.athoracsur.2010.08.041","volume":"91","author":"ZG Chen","year":"2011","unstructured":"Chen ZG, Luo HH, Peng YW, Cai LE, Zhang JL, Su CH, Zou JY: Comparative clinical features and immune responses after extended thymectomy for myasthenia gravis in patients with atrophic versus hyperplastic thymus. Ann Thorac Surg. 2011, 91: 212-218. 10.1016\/j.athoracsur.2010.08.041.","journal-title":"Ann Thorac Surg"},{"issue":"3A","key":"617_CR32","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/0002-9343(86)90118-X","volume":"80","author":"PL Lomen","year":"1986","unstructured":"Lomen PL, Samal BA, Lamborn KR, Sattler LP, Crampton SL: Flurbiprofen for the treatment of bone pain in patients with metastatic breast cancer. Am J Med. 1986, 80 (3A): 83-87.","journal-title":"Am J Med"},{"key":"617_CR33","volume-title":"Cochrane Database of Systematic Reviews","author":"A Sultan","year":"2009","unstructured":"Sultan A, McQuay HJ, Moore RA, Derry S: Single dose oral flurbiprofen for acute postoperative pain in adults. Cochrane Database of Systematic Reviews. 2009, (3), 0.1002\/14651858.CD007358.pub2. Art. No.: CD007358"},{"key":"617_CR34","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/S0304-3959(97)00120-6","volume":"73","author":"MT Roszkowski","year":"1997","unstructured":"Roszkowski MT, Swift JQ, Hargreaves KM: Effect of NSAID administration on tissue levels of immunoreactive prostaglandin E2, leukotriene B4, and (S)-flurbiprofen following extraction of impacted third molars. Pain. 1997, 73: 339-345. 10.1016\/S0304-3959(97)00120-6.","journal-title":"Pain"},{"key":"617_CR35","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/S0278-2391(10)80002-3","volume":"51","author":"JQ Swift","year":"1993","unstructured":"Swift JQ, Garry MG, Roszkowski MT, Hargreaves KM: Effect of flurbiprofen on tissue levels of immunoreactive bradykinin and acute postoperative pain. J Oral Maxillofac Surg. 1993, 51: 112-116. 10.1016\/S0278-2391(10)80002-3.","journal-title":"J Oral Maxillofac Surg"},{"key":"617_CR36","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1016\/0278-2391(90)90007-O","volume":"48","author":"ES Troullos","year":"1990","unstructured":"Troullos ES, Hargreaves KM, Butler DP, Dionne RA: Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. J Oral Maxillofac Surg. 1990, 48: 945-952. 10.1016\/0278-2391(90)90007-O.","journal-title":"J Oral Maxillofac Surg"},{"key":"617_CR37","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/0030-4220(85)90281-6","volume":"60","author":"AL Sisk","year":"1985","unstructured":"Sisk AL, Bonnington GJ: Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response. Oral Surg Oral Med Oral Pathol. 1985, 60: 137-145. 10.1016\/0030-4220(85)90281-6.","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"617_CR38","doi-asserted-by":"publisher","first-page":"598","DOI":"10.14219\/jada.archive.1984.0385","volume":"108","author":"RA Dionne","year":"1984","unstructured":"Dionne RA, Wirdzek PR, Fox PC, Dubner R: Suppression of postoperative pain by the combination of a nonsteroidal anti-inflammatory drug, flurbiprofen, and a long-acting local anesthetic, etidocaine. J Am Dent Assoc. 1984, 108: 598-601.","journal-title":"J Am Dent Assoc"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1749-8090-7-98.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1749-8090-7-98\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1749-8090-7-98","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1749-8090-7-98.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T20:36:50Z","timestamp":1744231010000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/1749-8090-7-98"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,9,29]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["617"],"URL":"https:\/\/doi.org\/10.1186\/1749-8090-7-98","relation":{},"ISSN":["1749-8090"],"issn-type":[{"type":"electronic","value":"1749-8090"}],"subject":[],"published":{"date-parts":[[2012,9,29]]},"assertion":[{"value":"9 February 2012","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2012","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2012","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"98"}}