The Effects of Anesthetics on Chronic Pain After Breast Cancer Surgery
The Effects of Anesthetics on Chronic Pain After Breast Cancer Surgery
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DOI：
10.1213/ane.0b013e31827ee372
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发表时间：
2013-03-01
影响因子：
5.7
通讯作者：
Kim, Choongrak
中科院分区：
文献类型：
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作者：
Cho, Ah-Reum;Kwon, Jae-Young;Kim, Choongrak
背景：乳腺癌术后慢性疼痛的发生率和预测因素已被广泛研究。由于慢性疼痛会对患者的日常生活产生负面影响，因此应该研究预防和减轻慢性疼痛及其严重程度的方法。我们之前的研究表明，与七氟醚麻醉相比，异丙酚麻醉对瑞芬太尼引起的痛觉过敏有抗痛觉作用，并能减轻急性疼痛。在这项研究中，我们调查了一个假设，即异丙酚可以预防乳腺癌手术后慢性疼痛的发展和严重程度，如急性疼痛。方法：对2007年3月至2008年12月期间接受乳腺癌手术的175名20 ~ 65岁女性（异丙酚组86名，七氟醚组89名）进行回顾性研究。2011年7月对患者进行电话随访。分析包括异丙酚组和七氟醚组之间慢性疼痛的发生率、严重程度和持续时间。严重程度分为轻度、中度和重度疼痛。慢性疼痛的持续时间按1年的时间间隔分为3类。与乳腺癌手术后慢性疼痛的发生率和严重程度相关的危险因素也被确定。结果：七氟醚组乳腺癌术后慢性疼痛发生率高于异丙酚组（95%可信区间[CI] 1.146 ~ 1.809, P = 0.007）。在慢性疼痛患者中，接受七氟醚和异丙酚治疗的患者的严重程度（95% CI 0.516-7.419）和持续时间（95% CI 0.106-1.007）均无差异。年龄较小（95% CI 0.907 ~ 0.992, P = 0.021）、腋窝淋巴结清扫（95% CI 1.204 ~ 1.898, P = 0.003）、术后24小时吗啡用量（95% CI 1.004 ~ 1.116, P = 0.036）、七氟醚（95% CI 1.146 ~ 1.809, P = 0.007）是慢性疼痛发生的预测因素。术后24小时吗啡用量增加（95% CI 1.001 ~ 1.379, P = 0.049）会加重慢性疼痛的严重程度。结论：本研究表明，与七氟醚麻醉相比，异丙酚麻醉与乳腺癌手术后慢性疼痛的发生率较低有关。然而，异丙酚对慢性疼痛的严重程度和持续时间没有显著影响。需要进一步的前瞻性研究来证实这些具有挑衅性的发现的有效性。（Anesth analy 2013;116:685-93）
BACKGROUND: The incidence and predictive factors for chronic pain after breast cancer surgery have been widely studied. Because it negatively affects patients' daily lives, methods to prevent and reduce chronic pain and its severity should be developed. Our previous study showed that propofol anesthesia has an antihyperalgesic effect under remifentanil-induced hyperalgesia and reduced acute pain compared with sevoflurane anesthesia. In this study, we investigated the hypothesis that propofol would prevent the development and severity of chronic pain after breast cancer surgery, as in acute pain.METHODS: A retrospective study was conducted with 175 women (n = 86 in the propofol group and n = 89 in the sevoflurane group) aged 20 to 65 years who underwent breast cancer surgery between March 2007 and December 2008. Patients were followed up by telephone in July 2011. Analysis included incidence, severity, and duration of chronic pain between propofol and sevoflurane groups. Severity was categorized into mild, moderate, and severe pain. Duration of chronic pain was also divided into 3 categories by 1-year time interval. Risk factors associated with the incidence and severity of chronic pain after breast cancer surgery were also identified.RESULTS: Chronic pain after breast cancer surgery was more likely to occur in the sevoflurane group compared with the propofol group (95% confidence interval [CI] 1.146-1.809, P = 0.007). Among patients With chronic pain, neither the severity (95% CI 0.516-7.419) nor duration (95% CI 0.106-1.007) differed between patients receiving sevoflurane and propofol. Younger age (95% CI 0.907-0.992, P = 0.021), axillary lymph node dissection (95% CI 1.204-1.898, P = 0.003), 24-hour postoperative morphine consumption (95% CI 1.004-1.116, P = 0.036), and sevoflurane (95% CI 1.146-1.809, P = 0.007) were predictive factors for the development of chronic pain. Higher 24-hour postoperative morphine consumption (95% CI 1.001-1.379, P = 0.049) increased the severity of chronic pain.CONCLUSIONS: This study showed that propofol anesthesia was associated with a lower incidence of chronic pain after breast cancer surgery than sevoflurane anesthesia. However, propofol did not have a significant effect on severity and duration of chronic pain. Further prospective studies are needed to confirm the validity of these provocative findings. (Anesth Analg 2013;116:685-93)