The Effect Of Multimodal Analgesia In Chronic Postoperative Pain After Modified Radical Mastectomy

Obejective：To explore the effect of introvenous Parecoxib sodium combined sufentanil-PCAin acute pain after modified radical mastectomy,and to investigate chronicpostsurgical pain and chronic neuropathic pain after3months.Methods：The study involved100women,ASAⅠ-Ⅱ,who received modified radicalmastectomy under general anesthesia.They were randomly divided into twogroups:control group(group S)and Parecoxib sodium group(group P).All the patientsaccepted preoperative HAD evaluation. For group P,parecoxib sodium40mg(dilutedto5ml with saline) was intravenously administered just5minute before operation.Forgroup S,intravenous injection of5ml of saline was conducted before operation.Afterthen,patients of group P were given40mg paracoxib sodium(diluted to5ml withsaline) respectively at6h、24h、48h after surgury.Patients of group S were conducted5ml of saline at at6h、24h、48h after surgury.All the patients were recieved tropisetronhydrocloride injection5mg and sufentail-PCA as soon as surgury.The resting and motion pain scores(VAS)、the dose of PCA were recorded at05h、6h、24h、48h repectively after surgury.Meanwhile,nausea,vomiting,bleeding andother adverse reaction were recorded.The incidences of chronic pain,the VAS of pain,ID pain scores,the characteristic of pain,the impact on the daily life were investigatedwith telephone interview after3month postoperatively.Results：1、There were no significant differences among each group of age,BMI,operation time and preoperative HAD scores（p>0.05）.2、No significant difference were found in the resting VAS between group P andgroup S at0.5h、6h after surgury（p>0.05）,but motion VAS of pain weresignificant lower in group P at each time points postoperatively（p<0.05）.Nosignificant differences of adverse effect were found（p>0.05）.3、There were no significant difference in the incidence of CPSP between group P andgroup S（p>0.05）,but the VAS scores in group P were lower than that in group S atpostoperative3month（p<0.05）.4、There were no significant difference of ID pain scores between two groups（p>0.05）.5、Regression analysis results showed that acute pain after surgury is a risk factor forCPSP（p<0.05）.Conclusions:1、Intravenous injection of parecoxib sodium combined sufentail-PCA have betterpostoperative pain analgesia in modified radical mastectomy for breast cancerpatients.It can reduce both resting and motion pain without increasing side effect.2、Parecobix sodium given postoperatively has obvious advantages in pain relief after3month.3、The patients who had CPSP got high ID pain scores,which may improve they hadneuropathic pain.4、Acute postoperative pain is a high risk factor for CPSP.