Effects Of Precision Anesthesia On Postmastectomy Pain Syndrome In Patient Undergoing Breast Cancer Surgery

Background:Postmastectomy pain syndrome（PMPS）is often accompanied by breast cancer surgery,which usually presents with chronic pain in the chest,axilla,upper arm after surgery.At present,the mechanism of PMPS have not been fully defined.Studies have shown that the type of surgery,preoperative anxiety,radiotherapy,chemotherapy,age,and management of postoperative acute pain are the important risk factors for PMPS.Due to the complex etiology and mechanism of PMPS,Treatment once it occurs is often ineffective.Therefore,It is important to take measures to prevent PMPS during perioperative period.In recent years anesthesiology has advocated a shift towards perioperative medicine and improving the safety and quality of perioperative patients.At the same time,with the development of anesthesiology,precision anesthesia has gradually become an important part of precision medicine,which includes a series of strategies related to anesthesia management throughout the perioperative period.More and more attention has been paid to the development of pain treatment in the direction of precision medicine.Objective:To evaluate the effect of optimized perioperative management under precision anesthesia on postmastectomy pain syndrome（PMPS）in patient undergoing breast cancer surgery.Methods:A total of 80 female patients scheduled for unilateral modified radical mastectomy were randomly divided into two groups:precision anesthesia group（Group P,n=40）and traditional general anesthesia group（Group R,n=40）.Patients in group P were receiving precision anesthesia strategy,It includes preoperative anti-anxiety,advanced analgesia,anti-inflammatory,multimodal analgesia and postoperative rehabilitation,whereas patients in group R were treated with traditional anesthetic management based on clinical experience.The following information of patients was recorded:The consumption of remifentanil and propofol during operation,the times of effective delivered doses 48 h after operation.and Visual analogue scale（VAS score）at 1h,6h,12h,24h,36h and 48h(T_1-6)after operation.The concentrations of IL-6 and TNF-αwere measured before surgery（T₀）and at 1h,24h and 48h after operation（T₁,T₄and T₆）.The incidence of PMPS were recorded at3,6,9 and 12 months after operation.Postoperative drowsiness,nausea and vomiting（PONV）,puncture complications and other adverse reactions were recorded.Results:（1）In this study,71 patients were included in the analysis,including 35 patients in group P and 36 patients in group R.There were no significant differences in age,BMI,ASA classification,surgical site,operative time and blood loss between the two groups（P>0.05）.The total cost of group P was slightly higher,but the difference was not statistically significant（P>0.05）.（2）Compared with the Group R,the consumption of remifentanil and propofol and VAS score at 1h,6h,12h,24h,36h and 48h(T_1-6)after operation were significantly lower in the Group P（P<0.05）.（3）There was no significant difference in the concentrations of IL-6 and TNF-αbetween the two groups before surgery（T₀）（P>0.05）.Compared with the Group R,The concentration of IL-6 and TNF-αat 1h,24h and 48h after operation（T₁,T₄and T₆）were decreased in the Group P(（P<0.05）.Compared with T₀,the concentrations of IL-6 and TNF-αincreased at 1h,24h and 48h（T1,T4 and T6）after operation in group R,and those increased at 1h and 24h（T1 and T4）postoperatively in group P（P<0.05）.（4）Compared with the Group R,The incidence of PMPS at 3,6,9,and 12months after operation were decreased（P<0.05）.Conclusion:Precision anesthesia strategy can reduce the incidence of postmastectomy pain syndrome（PMPS）and relieve postoperative chronic pain.