Effects Of Preoperative Low-dose Of Nalmefene On Postoperative Pain And IL-6 In Patients With Lung Cancer Undergoing Video-assisted Thoracic Surgery

Objective:Nowadays,lung cancer is the malignant tumor with the highest mortality rate around the world,and the crucial means treating it is VATS（Video-Assisted Thoracoscopic Surgery）.VATS is less invasive than traditional thoracoscopic surgery,but postoperative pain still affects postoperative recovery and quality of life.Some studies have revealed that the application of low-dose opioid receptor inhibitors can alleviate pain,affect immune regulation and reduce postoperative adverse reactions.At present,there are few studies on postoperative pain and immunity in patients with lung cancer with low-dose of nalmefene before operation.Therefore,the purpose of this study is to probe into the effects of low-dose nalmefene on postoperative pain and IL-6 regulation in patients with lung cancer under VATS,and to observe its effect on postoperative adverse reactions,providing more effective treatment strategies for improving the quality of postoperative life.Methods:Sixty patients underging VATS with general anesthesia met protocols were enrolled,randomly divided into two groups:Group N（nalmefene 0.25μg/kg）and Group S（saline 2 m L）.Low flow oxygen is inhaled in operating room.And the basic vital signs such as heart rate,invasive arterial blood pressure,blood oxygen saturation,end-expiratory carbon dioxide pressure and BIS（bispectral index）were monitored.Saline or nalmefene was injected intravenously five minutes before routine anesthesia induction.Patients in both groups were anesthetized with midazolam 0.05mg/kg,sufentanil 0.5μg/kg,cis atracurium 0.2 mg/kg and propofol 2 mg/kg.During the operation,the depth of anesthesia was maintained by continuously infusing propofol,remifentanil and cis atracurium.The infusion rate of propofol was adjusted maintaining BIS at 45～60.3m L of blood drained at admission（T₀）,1 hour after extubation（T₃）and 24 hours after operation（T₆）were placed in EDTA.CD4⁺T cells and CD8⁺T cells were detected by flow cytometry,and the concentrations of IL-6 and OGF in serum samples were detected by ELISA.The heart rate and mean arterial pressure were recorded at admission（T₀）,intubation（T₁）,extubation（T₂）and 1 h（T₃）,6h（T₄）,12 h（T₅）and 24 h（T₆）after operation.VAS at rest and exercise at 1 h（T₃）,6 h（T₄）,12 h（T₅）and 24 h（T₆）after operation were recorded.The occurrence of bucking during intubation,intraoperative dosage of propofol,remifentanil and sufentanil,opioid-related adverse reactions and the use of postoperative rescue analgesics within 24 hours were recorded.Results:In resting state,the VAS score of T₄and T₅in Group N was lower than that of the Group S,while in exercise condition the VAS at T₅in Group N was lower than that of the Group S.Compared with Group S,whole dose of postoperative analgesics within 24 hours in group N was significantly lower,and the first postoperative analgesia time in Group N was significantly longer（P<0.05）.Compared with Group S,the concentration of IL-6 in Group N dropped significantly at T3（P<0.05）.Compared with Group N,the concentration of OGF in Group S at T₃was significantly higher（P<0.05）.The extubation time in Group N was significantly shorter than that in Group S（P<0.05）,and the incidence of bucking during intubation in Group N was significantly lower than that in Group S（P<0.05）.Compared with Group S,the incidence of postoperative adverse reactions in Group N was significantly lower（P<0.05）.Conclusion:Intravenous administration of low dose of 0.25μg/kg nalmefene before induction can improve the pain condition on the first day after VATS,reduce the amount of postoperative rescue analgesic and reduce the level of IL-6 affecting the immune regulation.The application of low-dose of nalmefene can decrease the occurrence of postoperative opioid-related adverse reactions,the incidence of intubation bucking and shorten bearing tube time.