Effect Of Dexmedetomidine Combined With Ketorolac On The Analgesic Effect And Depression After Radical Mastectomy For Breast Cancer

Objective:To study the effect of Dexmedetomidine combined with ketolorac on postoperative analgesia and depression in breast cancer patients,and whether it can reduce the incidence of postoperative aderse reactions compared with the use of opioids alone.Grouping:The patients be selected are those who underwent radical mastectomy in the First Hospital of Jilin University from December 2019 to October 2020.They were 35-65 years old and had ASA classification I-III.Group of experiments: 80 patients meeting the inclusion criteria were selected and randomly divided into two groups,namely control group(group A)and experimental group,with 40 cases in each group.Method:Group A was connected with a disposable self-control infusion pump through a peripheral venous indwelling needle half an hour before the end of the operation(sufentanil100 μ g,dorasetron 25 mg,etc.were prepared to 100 ml after adding a certain amount of physiological saline).Half an hour before the end of the operation,the patients in group B were connected to the disposable self-control infusion pump through the peripheral venous indwelling needle(Dexmedetomidine 400 μ g,ketorolac tromethamine 90 mg,dorasetron 25㎎ and so on,which were prepared to 100 ml after adding a certain amount of normal saline).Visual analogue scale(VAS)was used to evaluate the degree of pain at 4h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after operation,and the effective pressing times of analgesia pump at the end of operation(T1)and 48 h after operation(T4)were recorded.The incidence of adverse reactions was recorded 48 hours after operation.Self rating Depression Scale(SDS)and 24 item Hamilton depression score(HDRS)were used to compare the depressive symptoms of the two groups one day before operation(T0),three days after operation(T6)and seven days after operation(T7).The higher the score,the more serious the depressive mood of the patients.The higher the score,the more severe the patient’s depression.Results:(1)There was no significant difference in VAS pain score between group A and group B at 4 h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after operation(P > 0.05);there was no significant difference in pressing times of analgesia pump between group A and group B within 48 h after operation(P > 0.05).(2)At t6-t7,SDS and HDRS depression scores in group A were significantly higher than those in group B(P < 0.05).(3)48 hours after operation,the incidence of adverse reactions such as nausea,vomiting,constipation,dry mouth and skin pruritus in group A was significantly higher than that in group B(P < 0.05);in the aspect of wound hematoma,there was no significant difference between group A and group B(P > 0.05).(4)There was no significant difference in the levels of alt,AST,Cr and PLT between group A and group B one week after operation(P > 0.05)Conclusion:(1)Dexmedetomidine combined with ketorolac has the same analgesic effect as sufentanil,that is,the combination of Dexmedetomidine and ketorolac can replace opioids for postoperative analgesia in patients with radical mastectomy.(2)Dexmedetomidine combined with ketorolac instead of sufentanil can effectively relieve the depression of patients after radical mastectomy.(3)Dexmedetomidine combined with ketorolac can effectively reduce the incidence of adverse reactions such as nausea,vomiting,constipation,dry mouth and skin itching caused by opioids.(4)Dexmedetomidine combined with ketorolac have no affect the coagulation function of patients and does not increase the risk of bleeding.