Preemptive Flurbiprofen Axetil for Sleep-Pain-Inflammation Modulation After Laparoscopic Gynecological Surgery: A Prospective, Parallel-Group Randomized Controlled Trial

Xin Huang^1,2,3Wenxin Wei^4,5Zhihao Leng⁶Bijia Song⁷Ming Fu⁴Jiangshan He⁴Junchao Zhu^4*

• ¹Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
• ²Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
• ³Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
• ⁴Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
• ⁵Department of Anesthesiology, The Fourth People's Hospital of Shenyang, Shenyang, China
• ⁶Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology,, Wuhan, China
• ⁷Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, China

Background: Postoperative pain, inflammation, and sleep disturbances commonly arise after laparoscopic gynecological surgery and are increasingly recognized as interconnected factors that impede recovery and diminish quality of life. Flurbiprofen axetil, a NSAID, is widely used during the perioperative period for pain management. Its potential to modulate inflammatory pathways and nociceptive transmission, thereby enhancing postoperative sleep quality, remains underexplored. Additionally, the optimal timing for NSAID administration—preoperative versus postoperative—remains debated, with limited evidence addressing its impact on sleep outcomes. Objective: This study investigates the impact of preoperative compared to postoperative use of flurbiprofen axetil on pain, systemic inflammatory responses, and particularly the sleep quality in patients undergoing laparoscopic gynecologic operations. Methods: In this prospective, randomized controlled trial, 98 patients undergoing laparoscopic gynecological surgery were assigned to receive 50 mg of flurbiprofen axetil either 15 minutes prior to surgery (PreFA group) or at the end of surgery (PostFA group). The primary outcomes included postoperative pain intensity (visual analog scale, VAS), sleep quality (Athens Insomnia Scale, AIS), and systemic inflammatory markers (SII, NLR, and MLR). Outcome data were collected by blinded assessors at predefined time points: preoperatively, and 24/72 hours postoperatively. Results: The baseline characteristics were similar between groups. The PreFA group demonstrated significantly lower VAS scores for resting and exertional pain at 24 and 72 hours after surgery (P < 0.05). AIS scores were also substantially lower in this group on postoperative days 1 and 3 (P < 0.001 and P = 0.002), reflecting improved sleep quality. Inflammatory markers (SII, NLR, MLR) were elevated postoperatively in both groups but remained significantly lower in the PreFA group (all P < 0.05). Additionally, the incidence of postoperative nausea and vomiting was reduced in the PreFA group. Conclusion: Preoperative administration of flurbiprofen axetil not only improved postoperative analgesia and reduced inflammatory responses but also significantly enhanced sleep quality, an essential yet underestimated component of recovery. These findings underscore the broader physiological benefits of preemptive NSAID use and emphasize the importance of timing in analgesic strategies. Incorporating flurbiprofen axetil into preemptive multimodal analgesia protocols could provide a straightforward, effective approach to optimizing recovery following laparoscopic gynecological surgery.