Effect of Ketamine Combined with Flurbiprofen Axetil on Preemptive Analgesia in Patients Undergoing Radical Mastectomy and its Postoperative Pain Mediator and Cardiovascular Response
LIU Jun, ZHOU Ying, CAI Zhiyong,et al
Yulin Red Cross Hospital, Guangxi Yulin 537000, China
Abstract:Objective: To analyze the effect of ketamine combined with flurbiprofen axetil on preemptive analgesia in patients undergoing radical mastectomy and its postoperative pain mediator and cardiovascular response. Methods: 230 cases of breast cancer who treated from April 2017 to April 2018 in our hospital, according to the simple random number table method those patients were divided into 102 control groups and 128 observation groups. control group used flurbiprofen axe to induce analgesia, observation group used flurbiprofen axetil combined with ketamine to induce analgesia. Then awakening time, extubation time and waking time, pain medium, visual analog scale (VAS) and intravenous controlled analgesia (PCIA) compressions, blood flow at different time points, cardiovascular reactions, adverse reactions in both group were compared. Results: awakening time, extubation time and waking time in both group were no statistically significant differences (P>0.05). 12h after surgery and 24h after surgery, the levels of adenosine E2 (PGE2), substance P (SP), and 5-hydroxytryptamine (5-HT) in both groups were all increased, and the levels ofβ-endorphin (β-EP) was decreased, and the change range of the observation group were smaller (P<0.05). 3h, 12h and 24h after surgery, VAS score and PCIA presses in both groups were increased, and the observation group were lower than the control group (P<0.05). after operation and extubation,HR and MAP in both groups were increased, while the observation group had a smaller rised (P<0.05). The incidence of hypertension in the observation group was lower than that in the control group (P<0.05). Conclusion: Preemptive analgesia with ketamine combined with flurbiprofen axetilcan alleviate postoperative pain in patients undergoing radical mastectomy,it inhibits the secretion of pain-causing mediators, reduces cardiovascular reactions, and does not increase the incidence of adverse reactions.
刘军, 周颖, 蔡志勇, 余松峰. 氯胺酮复合氟比洛芬酯超前镇痛对乳腺癌根治术患者术后疼痛介质及心血管反应的影响[J]. 河北医学, 2019, 25(10): 1658-1662.
LIU Jun, ZHOU Ying, CAI Zhiyong,et al. Effect of Ketamine Combined with Flurbiprofen Axetil on Preemptive Analgesia in Patients Undergoing Radical Mastectomy and its Postoperative Pain Mediator and Cardiovascular Response. HeBei Med, 2019, 25(10): 1658-1662.
[1] Li J, Serafin E, Baccei ML. Prostaglandin signaling governs spike timing-dependent plasticity at sensory synapses onto mouse spinal projection neurons[J].Neurosci,2018,38(30):6628~6639. [2] 张倩,尤浩军.“超前镇痛”研究进展及麻醉中应用[J].中国疼痛医学杂志,2016,22(4):241~244. [3] 柴林,甘建辉,郑智文,等.氟比洛芬酯超前镇痛对老年肿瘤患者术后镇痛及血浆细胞因子的影响[J].河北医药,2014,36(1):17~19. [4] Othman AH, El-Rahman AM, El Sherif F. Efficacy and safety of ketamine added to local anesthetic in modified pectoral block for management of postoperative pain in patients undergoing modified radical mastectomy[J]. Pain Physician,2016,19(7):485~494. [5] Vieira JS, Toreti JA, de Carvalho RC, et al. Analgesic effects elicited by neuroactive mediators injected into the ST 36 acupuncture point on inflammatory and neuropathic pain in mice[J].Acupunct Meridian Stud,2018,11(5):280~289. [6] 沈明敬,徐中华,徐忠恒,等.氟比洛芬酯对胸外科手术超前镇痛效果观察[J].中国疼痛医学杂志,2014,20(10):760~762. [7] 孙国强,李杰,冯宪光.氟比洛芬酯超前镇痛在乳腺癌根治术中的应用观察[J].中国现代普通外科进展,2017,20(3):222~223. [8] Lanier ST, Lewis KC, Kendall MC, et al. Intraoperative nerve blocks fail to improve quality of recovery after tissue expander breast reconstruction: a prospective, double-blinded, randomized, placebo-controlled clinical Trial[J]. Plast Reconstr Surg,2018,141(3):590~597. [9] Zhou L, Li Y, Li X, et al. Propranolol attenuates surgical stress-induced elevation of the regulatory T cell response in patients undergoing radical mastectomy[J].Immunol,2016,196(8):3460~3469.