Bourazani Maria, Papageorgiou Effie, Zarkadas Georgios, Petrakopoulou Theodora, Kaba Evridiki, Fasoi Georgia, Kelesi Martha
Department of Anesthesiology, Hellenic Anticancer Institute, Saint Savvas Hospital, Greece. Email:
Department of Medical Laboratories, University of West Attikis, Greece.
Asian Pac J Cancer Prev. 2019 Mar 26;20(3):743-749. doi: 10.31557/APJCP.2019.20.3.743.
Purpose: Post-operative pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience post-operative pain syndromes in approximately one-half of all cases. Patients who have undergone breast reconstruction after mastectomy can suffer from acute postoperative pain with moderate or strong tension. In some cases, chronic neuropathic pain syndromes may occur after surgery. Opioids are used to treat pain, with serious side effects. The systemic postoperative analgesic regimen as thiocochlicoside P.O. along with paracetamol and NSAIDs I.V., which may limit the administration of opioids without reducing pain relief, seems to be necessary. Materials and Methods: This study was a clinical trial randomizing 70 patients undergoing breast reconstruction. Two main protocols of systematic post-operative analgesia, one using thiocochlicoside (group A) and the other without them (group B), were used. Both groups received paracetamol X3 and lornoxicam X2 I.V. systematically. The pain measurement scale (NPS) used to measure post-operative pain. Likert scales were used to evaluate patient’s satisfaction and the difficulty from the side effects . An anonymous questionnaire was used for the data collection. Results: Statistically significant difference was found between pain on the day of surgery (p = 0.017) as well as the three subsequent days (p = 0.000). In group A , pain was reduced directly to half (Χ2 surgery pain = 93.888, p = 0.000) especially on the first post-operative day. In group A the satisfaction with analgesic treatment was higher than in group B (p = 0.002). Conclusion: The use of thiocochlicoside in post-operative analgesia in breast reconstruction after mastectomy contributes to reduce the pain intensity experienced by patients and to reduce the side effects of opioid analgesics as a result of reduced demand for opioid analgesics. Patients who received the analgesia using muscle relaxants-spasmolytic reported greater satisfaction.
乳腺癌手术后的疼痛是一个主要问题，接受乳房切除术和乳房重建的女性中约有一半会经历术后疼痛综合征。乳房切除术后进行乳房重建的患者可能会遭受中度或强烈张力的急性术后疼痛。在某些情况下，术后可能会出现慢性神经性疼痛综合征。阿片类药物用于治疗疼痛，但有严重的副作用。全身性术后镇痛方案，如口服硫代秋水仙苷以及静脉注射扑热息痛和非甾体抗炎药，在不降低疼痛缓解效果的情况下可能会限制阿片类药物的使用，这似乎是必要的。
本研究是一项对70例接受乳房重建的患者进行随机分组的临床试验。使用了两种主要的系统性术后镇痛方案，一种使用硫代秋水仙苷（A组），另一种不使用（B组）。两组均系统性地静脉注射扑热息痛X3和氯诺昔康X2。使用疼痛测量量表（NPS）来测量术后疼痛。使用李克特量表评估患者的满意度以及副作用带来的困扰。通过一份匿名问卷收集数据。
在手术当天（p = 0.017）以及随后的三天（p = 0.000），两组疼痛存在统计学上的显著差异。在A组，疼痛直接减轻了一半（Χ2手术疼痛 = 93.888，p = 0.000），尤其是在术后第一天。A组对镇痛治疗的满意度高于B组（p = 0.002）。
在乳房切除术后乳房重建的术后镇痛中使用硫代秋水仙苷有助于降低患者经历的疼痛强度，并由于对阿片类镇痛药需求的减少而降低阿片类镇痛药的副作用。使用肌肉松弛剂 - 解痉剂进行镇痛的患者报告的满意度更高。
