Effects And Mechanism Of Postoperative Analgesia With Dezocine On Early Negative Emotions And Sleep Quality In Patients Undergoing Non-cardiac Surgery

Objectives:Depression and anxiety are the most common manifestations of negative emotions in clinical surgical patients.In particular,perioperative anxiety and depression in patients with tumors are widespread,and the proportion of patients’ recovery and prognosis affected by negative emotions is increasing.Negative emotions in the perioperative period increase pain sensitivity;affect the recovery of body function,sleep quality,and excessive use of opioids;lead to perioperative neurocognitive disorders;and increase mortality.With the transformation of the biopsychosocial medical model,the prevention and treatment of emotional changes,especially anxiety and depression,has become a hot research topic in anesthesia,surgery,and nursing.Presently,the treatment of depression and anxiety is based on the clinical symptoms,related scale evaluation,comprehensive judgment,and diagnosis before further intervention treatment by psychiatrists.Preventive treatment,especially perioperative prevention and treatment of depression,anxiety,and other adverse emotions,is still rare.Dezocine is commonly used in patient-controlled intravenous analgesia(PCIA)in clinical patients.It can produce good analgesia through the action of opioid receptors and also inhibit the reuptake of 5-hydroxytryptamine and norepinephrine.Previous studies have suggested that dezocine may improve patients’ sleep quality and negative emotions,but it is still unclear.To further clarify the effect of dezocine on postoperative sleep and negative emotions,we first retrospectively analyzed whether postoperative analgesia of dezocine combined with sufentanil can improve postoperative sleep quality of patients with noncardiac surgery.We studied the effect of dezocine combined with sufentanil PCIA on early negative emotions and sleep quality of patients with colorectal cancer by equivalent doses of postoperative analgesic drugs.In addition,we used the mouse incision pain model to observe whether dezocine can improve the sleep time induced by pentobarbital sodium.Methods:1.Based on the inclusion–exclusion criteria,4364 patients undergoing noncardiac surgery at the Second Affiliated Hospital of the Army Medical University from May 2018 to April 2019 were recruited by searching the hospital operation anesthesia system and hospital electronic medical record system.With development of sleep disorder as the dependent variable,the relevant factors influencing sleep disorder on the day after the operation were screened through logistic regression analysis.To determine the effect of postoperative analgesia with dezocine on sleep disorders of patients undergoing noncardiac surgery on the day after surgery,according to the relevant factors affecting sleep disorders postoperatively,propensity score matching was used to eliminate the confounding factors.The difference in sleep disorders on the same day between the dezocine group(n=997)and pentazocine group(n=997)was analyzed.2.From May 2018 to September 2018,120 patients with colorectal cancer who met the inclusion criteria were recruited from the Second Affiliated Hospital of the Army Medical University.This was a randomized,parallel-controlled,double-blind,single-center trial.Beck’s Depression Inventory(BDI)and Beck’s Anxiety Inventory(BAI)were applied to measure the patients’ preoperative depression and anxiety scores.A prospective,randomized,controlled,double-blind single-center trial was conducted to compare the BDI scores 2 days postoperatively in patients with colorectal cancer who received postoperative PCIA with dezocine with sufentanil(dezocine group)and sufentanil(control group).3.A mouse model of incisional pain was established,and the effects of different equivalent doses of analgesics on different pain types(mechanical pain and thermal pain)in mice were observed.In addition,the effects of different analgesic drugs on the sleep time of pentobarbital sodium-induced mice were observed.Results:1.A total of 4364 patients undergoing noncardiac surgery were retrospectively analyzed.Logistic regression analysis showed that postoperative analgesia with dezocine was one of the factors related to sleep disorders in the dezocine group(Ref.pentazocine;OR =0.66;95% confidence interval [CI],0.55–0.80;P<0.0001).Before unmatching,the incidence rates of sleep disorders on the day of operation in the dezocine and pentazocine groups were 10.7% and 18.2%,respectively(P < 0.0001).A total of 997 patients were successfully matched by propensity score matching.The incidence of sleep disorders on the day of surgery in the dezocine group was significantly lower than that in the pentazocine group(10.6% vs.16.1%,P < 0.0001).2.From May 2018 to September 2018,we included and followed a total of 120 patients with colorectal cancer.The mean postoperative BDI score 2 days after surgery in the dezocine group was significantly lower than that in the control group(7.27±3.38 vs.9.92±3.52,P<0.001).The mean difference between the two groups was 2.6(95% CI,1.4-3.9).In addition,the night sleep quality was better in the dezocine group than in the control group on the day of surgery(good,34 [56.7%] vs.20 [33.3%];average,16 [26.7%] vs.26 [43.3%];poor,10 [16.6%] vs.14 [23.4%];,P=0.035)and 1 day postoperatively(44 [73.3%] vs.23 [38.3%],11 [18.3%] vs.28 [46.7%],5 [8.4%] vs.9 [15.0%];P<0.001).In the dezocine group,the odds ratio of good sleep on the day of surgery was 1.70(95% CI,1.11-2.59,P=0.010),and that at 1 day after surgery was 1.91(95% CI,1.34-2.73,P < 0.001).Both the serum serotonin(535±142 vs.470±139 ng/L,P=0.013)and norepinephrine levels(199±40 vs.174±49 ng/L,P=0.002)at 1 day after surgery were higher in the dezocine than in the control group.Similarly,at 2 days postoperatively,both serum serotonin(532±147 vs.473±127 ng/L,P=0.022)and norepinephrine levels(205±46 vs.183±41 ng/L,P=0.008)were higher in the dezocine than in the control group.Both serum serotonin(535±142 vs.470±139 ng/L,P=0.013)and norepinephrine levels(199±40 vs.174±49 ng/L,P=0.002)at 1 day postoperatively were higher in the dezocine group than in the control group.Similarly,at 2 days postoperatively,both serum serotonin(532±147 vs.473±127 ng/L,P=0.022)and norepinephrine levels(205±46 vs.183±41 ng/L,P=0.008)were higher in the dezocine group than in the control group.3.Compared with the saline control group,the dezocine group significantly relieved the mechanical and thermal pain thresholds(P < 0.001;P < 0.05).There was no significant difference in analgesic effect among the dezocine,sufentanil,and morphine groups(P > 0.05).Compared with the saline,sufentanil,and morphine groups,the dezocine group significantly improved the pentobarbital sodium-induced sleep time(P = 0.016;P = 0.016;P = 0.019).Conclusions:1.Compared with pentazocine,the postoperative use of dezocine combined with sufentanil PCIA can not only relieve pain in patients undergoing noncardiac surgery but also reduce postoperative sleep disorders and improve sleep quality.2.The use of dezocine combined with sufentanil PCIA during the 48-h postoperative period can decrease BDI scores and relieve postoperative depression symptoms while effectively relieving postoperative pain in patients undergoing colorectal cancer surgery.Moreover,dezocine has significant benefits in terms of postoperative sleep quality on the day of surgery and 1 day after surgery.3.The postoperative use of dezocine can effectively relieve mechanical and thermal pain in the mouse incision pain model and prolong the sleep time induced by pentobarbital sodium.