| Background:Breast cancer is the most common cancer in women.Surgical treatment is one of the most effective methods to treat breast cancer.20%～50% of women have chronic pain after breast cancer related surgery,so the prevention and treatment of chronic pain after breast cancer surgery has become an important clinical topic.Research shows that most female patients with breast cancer are in menopause,and the hormone changes are obvious.As an important female special organ,breast surgery often causes anxiety in patients.11% of patients show depression before surgery,and the incidence of sleep disorders can be as high as 32.25%.Research shows that sleep disorders and pain interact.Sleep disorders can cause patients to increase pain sensitivity and consume more analgesic drugs after surgery.Animal experiments have shown that elevated glucocorticoid levels are associated with increased pain sensitivity in sleep deprived mice.Studies have reported that a single oral dose of hydrocortisone in healthy people can cause increased visceral pain sensitivity within 2 hours.Long-term administration of0.25 mg of dexamethasone in healthy people also increases the incidence of chronic pain.Abnormal increases in glucocorticoid levels are associated with increased pain sensitivity in people with sleep disorders or healthy individuals.Dexamethasone is a long-term glucocorticoid with anti-inflammatory and anti-shock effects,which is widely used for postoperative analgesia and prevention of postoperative nausea and vomiting(PONV).However,whether or not dexamethasone injection during anesthesia has analgesic effect on breast cancer patients with sleep disorder after surgery,and how pain sensitivity affects has not been studied.Methods:From December 2022 to February 2023,96 female patients with sleep disorder(each patient sleeps less than 5 hours two nights before surgery)who are planning to undergo radical surgery for breast cancer in the First Hospital of Jilin University,aged over 18 years,weighing45-80 kg,ASA grade I or II,were selected.Subjects completed a Pain Sensitivity Questionnaire(PSQ)before surgery to determine their basic pain sensitivity,and were randomly divided into two groups: the dexamethasone group and the control group.Routine monitoring of vital signs and induction of anesthesia were performed after admission:patients in both groups received intravenous dexamethasone 8 mg or saline,while patients in both groups received propofol 1.5 to 2 mg/kg and sufentanil 0.2 to 0.3 μg/kg,rocuronium 0.6 mg/kg.Tracheal intubation was performed 3 to 4 minutes later,and mechanical ventilation was performed after auscultation and localization of both lungs.Anesthesia maintenance: 0.6～1.0 MAC sevoflurane,remifentanil0.05～0.2 μg/(kg·min),propofol 4 to 8 mg/(kg·h),rocuronium was added as needed,and diazosine and ondansetron were injected intravenously after surgery.If severe pain occurs,diclofenac sodium sustained-release tablets were administered 75 mg and blood glucose was monitored.Record the general information of the patient before surgery,and record the anesthesia time,surgical time,anesthetic dosage,and whether to perform axillary lymph node dissection during anesthesia.The visual analog scale(VAS)was collected at 2,6,12,24,and 48 hours after surgery,and the percentage of patients with a VAS score ≥ 3 at 1month after surgery was collected.The use rate of relief analgesic drugs within 48 hours after surgery,the incidence of PONV,the fasting blood glucose value on the next day after surgery,and the incidence of wound infection.Result:(1)There was no significant difference in preoperative general information(including age,height,weight,BMI,PSQ score,ASA grade,and educational background)between the two groups(P >0.05).(2)There were no statistically significant differences in anesthesia time,operative time,dosage of sufentanil,dosage of remifentanil,dosage of propofol,percent of axillary lymph node dissection(P>0.05).(3)Compared with the control group,the VAS scores of the dexamethasone group at 2h,6h,12 h,24h,and 48 h after surgery were significantly lower than those of the control group(P <0.05).There was no statistically significant difference in the percentage of patients with VAS score ≥ 3 in the first month after surgery(P >0.05).(4)Compared with the control group,the incidence of PONV in the dexamethasone group was lower,with a statistically significant difference(P <0.05).In the dexamethasone group,the use of salvage analgesics was reduced 48 hours after surgery,and the fasting blood glucose was increased the next day after surgery(P <0.05).However,there was no statistically significant difference in wound infection rates(P >0.05).Conclusion:A single preoperative injection of dexamethasone 8 mg can reduce the pain sensitivity within 48 hours after breast cancer surgery with sleep disorder,but does not reduce the pain sensitivity 1 month after surgery.Dexamethasone 8 mg decreased the incidence of PONV,reduced the use of postoperative salvage analgesics,and increased fasting blood glucose the next day after surgery,but had no significant impact on wound infection rates. |
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