Application Of Enhanced Recovery After Surgery In Anesthesia Management For Modified Radical Mastectomy

Objective:To compare and analyze the effect of anesthesia optimized management plan under the concept of enhanced recovery after surgery in modified radical mastectomy and its influence on the long-term quality of life of patients.Methods:Sixty patients undergoing modified radical mastectomy in the First Affiliated Hospital of Guangxi Medical University were randomly divided into two groups(n=30):control group(group C)and enhanced recovery after surgery group(group ERAS)applying anesthesia optimized management plan during perioperative period.The changes of MAP and HR of the two groups of patients were observed and recorded at three time points:entering the operating room(T_a),skin incision(T_b)and leaving the operating room(T_c).Anesthetic procedure,operation-related indicators and the perioperative adverse reactions were compared between the two groups.The blood glucose of the patients before anesthesia induction and at the end of the operation was recorded.The plasma concentrations of WBC,CRP and IL-6 were recorded before the operation and at the 1~stt and 3~rdd day after the operation.VAS scores at 2 h,6 h,12 h,24 h and 48 h after operation were compared between the two groups.The quality of life and the occurrence of chronic pain were evaluated 6 months after follow-up.Results:(1)MAP and HR of group ERAS patients at T_a time point were significantly lower than those of group C(P<0.05).However,there was no significant difference in MAP and HR between the two groups at T_b and T_c points(P>0.05).(2)There was no significant difference in operation time between the two groups(P>0.05).The time of tracheal catheter removal,PACU residence time and postoperative hospital stay in group ERAS were shorter than those in group C(P<0.05).(3)VAS scores in group ERAS at 2 h,6 h,12 h,24 hand 48 h after operation were significantly lower than those in group C(P<0.05).(4)The incidence of PONV and the rate of additional analgesics in group C were higher than those in group ERAS(P<0.05).(5)There was no significant difference in blood glucose levels between the two groups before induction of anesthesia(P>0.05),but only the blood glucose level of group C was increased at the end of surgery(P<0.05).There was no significant difference in WBC,CRP and IL-6 between the two groups before operation(P>0.05).Compared with the day before operations,the levels of WBC,CRP and IL-6 in the two groups were increased at the 1~stt day after operation,and the levels in group C were higher than that in group ERAS(P<0.05).At the 3~rdd day after operation,the levels of WBC and IL-6 in the two groups have recovered to the preoperative levels.The level of CRP in group C was still significantly higher than that in group ERAS at the 3~rdd day after operation(P<0.05).(6)The score of quality of life in group ERAS was significantly higher than that in group C at 6months after operation(P<0.05).The incidences of chronic pain in ERAS group was less than that in group C(P<0.05).Conclusion:The application of optimized anesthesia management plan based on the enhanced recovery after surgery strategy can provide satisfactory analgesic effect during the perioperative period of modified radical mastectomy with less postoperative complication,which can effectively improve the long-term quality of life of breast cancer patients.