| Research BackgroundRadical mastectomy and modified radical mastectomy can cause moderate postoperative pain. So postoperative analgesic is required.Excellent postoperative analgesia can inhibit the stress responses caused by pain and help the patients cough, expectoration, and early postoperative ambulation, can reduce pulmonary complications and deep vein thrombosis. Pethidine, morphine, tramadol and fentanyl, etc. are commonly used in clinical for postoperative pain relief, although the effects are exact, apparent side effects such as nausea, vomiting, itching, etc., brought trouble to the patients and their families.Parecoxib sodium is a new inhibitor of cyclooxygenase 2 (COX-2). It has no anti-platelet effect and does not increase the risk of bleeding, it is used for trauma and surgery-related short-term acute pain treatment in clinic, and achieved very satisfactory results.It has preemptive analgesia-But we do not know how to use this drug and get the better pain relief. So we used Parecoxib sodium at different time to find a reasonable method of medication.Research PurposesTo observe the clinical effect of postoperative analgesic and its influence on stress responses and adverse reactions of parecoxib sodium at different time points for modified radical mastectomy patients under general anesthesia, and evaluate safe and effective in postoperative pain relief of modified radical mastectomy.Research MethodsNinety patients with ASA gradeⅠtoⅡ, aged from 25 to 70 yeas old and undergoing modified radical mastectomy were selected. All the patients were given intravenous combined inhalation anesthesia. Tracheal intubation was performed after inducing with midazolam, fentanyl, propofol, cis-atracurium intravenous injection., Anesthesia was maintained with continuous infusion of propofol, remifentanil, and sevoflurane inhalation.Patients were randomly divided into three groups:group A (preoperative treatment group), group B (postoperative treatment group),and group N (control group). For group A, intravenous injection of 40 mg parecoxib sodium was conducted 30 min preoperatively 5ml of saline was given intravenously after breast tissue was removed. For Group B, intravenous injection of 5ml of saline was conducted 30 min preoperatively,40mg of parecoxib sodium was given intravenously after breast tissue was excised.For group N, intravenous injection of 5ml of saline was conducted at 30 min preoperatively and after breast tissue was excised respectively.5mg of tropisetron was given intravenously for all patients during skin closure to prevent nausea and vomiting. After tracheal extubation, transfer the patients to breast surgery wards, additional intramuscular injection of 75mg of pethidine was conducted according to the patient self-reports of pain.We recorded the pain scores (VAS) and sedation scores (Ramsay) at the different time after extubation:30min (T2),2h (T3),4h (T4),8h (T5),12h (T6),16h (T7),24h (T8),36h (T9) and 48h (T10).. Heart rates (HR) and MAP were recorded at 30min (T2),2h (T3),4h (T4) postoperatively. Pethidine dose used were recorded in 48h. Meanwhile, respiratory rate and circulatory depression and nausea, vomiting, bleeding, peripheral edema and other adverse reactions was conducted, patient's satisfaction scores were recorded.Analysis was conducted with statistical software SPSS17.0, All data was showed as mean±standard deviation (x±s), single factor analysis of variance was applied for the comparison between groups, Dunnett't 2-sided test was applied for pairwise comparisons, repeated measures analysis of variance was for comparisons of each time points within the group, chi-square test was for count data, P<0.05 will be taken as significant difference.Results1. There was no significant difference (P> 0.05) among three groups in age, weight, operation time and intraoperative fentanyl dosage.2. Resting VAS score: At T2 (30min postoperatively), the scores in group B and group N were higher than that in group A, the difference was statistically significant (P <0.05), while there was no significant difference between group B and group N (P> 0.05); at T3 (2h postoperatively) and T4 (4h postoperatively), the scores in group N is higher than that in group A and B, the difference was significant (P<0.05), there was no significant difference between group A and B; at different time points after T5 (8h postoperative), the resting VAS scores of the three groups tended to be close, there was no significant difference among the three groups (P> 0.05). Degree of satisfaction:group A (98.10±1.32), group B (95.85±2.23), both higher than the group N (89.27±2.3) (P<0.05).3.Compared with To, the HR at T1 and T2 increased in the three groups. HR in group N increased more than that in the groups A and B (P<0.01 and P<0.05). There was no significant difference in mean arterial pressure at each time points between group A and group B; the MAP increased significantly at T1,T2,T3 time points than that at To in group N, the difference was significant (P<0.05).4. All patients did not appear sedation at each time point postoperatively in three groups.5. Within 24h postoperative, nine patients in group N need to use pethidine; five patients in group B need to use pethidine; two patients in group A need to use pethidine.6. Less nausea and vomiting occurred in patients in each group, the difference was not significant (P> 0.05). Dizziness, headache, intravenous pain, pruritus and other adverse reactions were not observed in the three groups.Conclusions 1. Intravenous injection of 40mg of parecoxib sodium have better postoperative pain analgesia in modified radical mastectomy for breast cancer patients, can significantly reduce the excessive stress responses activated by surgical trauma, without increasing side effect.2. Compared with the treatment before the end of surgery, parecoxib sodium given preoperatively has obvious advantages in pain relief, and can reduce postoperative opioid dosage. |
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