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Objective:In order to accurately evaluate the postoperative rehabilitation of gynecological robotic surgery, a prediction model for evaluating postanesthesia care unit (PACU) extubation time and hospital stay in gynecological robotic surgery was established.Methods:The clinical data of gynecological patients who underwent robotic surgery in Xiangya Third Hospital of Central South University from October 2015 to May 2017 were retrospectively analyzed, and the data were screened to evaluate the postoperative recovery of patients from two aspects: PACU extubation time and postoperative hospital stay. Binary logistic regression was used to screen out the factors affecting PACU extubation time and postoperative hospital stay, and the prediction model was preliminarily established and verified.Results:Finally, there were 456 patients and 30 variables analyzed in the binary logistics regression. According to these variables, the prediction model of the postoperative recovery evaluation after gynecological robotic surgical procedures was established. Among them, age, intraoperative amount of atracurium and midazolam were independent risk factors affecting PACU extubation time (all P<0.05). American Society of Anesthesiologists (ASA) grade, intraoperative amount of midazolam, intraoperative bleeding and operation time were independent risk factors affecting postoperative hospital stay (all P<0.05). All models passed Hosmer lemeshow test (all P>0.05); The areas under the receiver operating characteristic curve (ROC) were 0.647 and 0.806, respectively. Conclusions:The prediction model of PACU extubation time and the postoperative hospitalization time has been established.
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Objective:To explore whether perioperative intravenous flurbiprofen axetil can reduce the incidence and intensity of chronic pain for breast cancer atfer surgical treatment. Methods:This randomized, double-blind, controlled trial enrolled 60 patients undergoing mastectomy and axillary lymph node dissection under general anesthesia. All patients accepted Hospital Anxiety and Depression Scale (HAD) tests the day before the surgery to evaluate depression and anxiety. hTe patients were randomly assigned to receive either 50 mg lfurbiprofen axetil intravenously 15 minutes before the surgical incision and 6 hours later (group F) or intravenous 5 mL intralipid as a control (group C). All patients received patient-controlled intravenous analgesia (PCIA) with fentanyl postoperatively. Peripheral venous blood samples were drawn before the surgery, at 4 and 24 h atfer the surgery to detect the plasma level of PGE2 and tumor necrosis factor-α(TNF-α). Postoperative fentanyl consumption, Numerical Rating Scale (NRS) scores and adverse effects were recorded at 2, 6, 12, 24 and 48 h after the surgery. hTe duration and intensity of pain were followed up by telephone at the 2nd-12th month atfer the surgery. Results:The incidence of pain at 2, 4, 6, and 12 months after the breast surgery was 33%, 20%, 15%, and 10%, respectively, and the average pain score was 0.77, 0.57, 0.28, and 0.18, respectively. Compared with group C, the scores of pain in group F were significantly lower at 2, 4, 6 and 12 months postoperatively (F=7.758, P=0.007). The incidence of pain in group F was significantly lower at 2, 4 and 6 months postoperatively (P0.05). Preoperatively and at 4 and 24 h atfer the surgery, there was no signiifcant difference in the level of TNF-αbetween the two groups (F=0.530, P=0.470);but plasma concentration of PGE2 in group F was significantly lower than that in group C (F=5.646, P=0.021). No patients developed abnormal bleeding, peptic ulcer, impaired liver or renal function and respiratory depression. Conclusion:Perioperative intravenous infusion of 100 mg flurbiprofen axetil can decrease the intensity and incidence of chronic pain for breast cancer atfer surgical treatment.
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OBJECTIVE@#To set up a mouse model with bone cancer to simulate the morphine tolerance and explore its mechanism.@*METHODS@#Forty C57BL/6 male mice were divided into 4 groups: Group 1 and Group 2 were firstly set up as bone cancer pain models. Morphine (10 mg/kg) was sequentially administered subcutaneously twice daily in Group 1 and normal saline was administered in Group 2 as the control group. Similar to Group 1 and Group 2, morphine (10 mg/kg) was administered subcutaneously twice daily in Group 3 and normal saline was administered in Group 4 as the control group. To set up morphine tolerance model, we injected morphine continuously for 7 days. From Day 1 to Day 7 after the morphine injection, we measured the mice hind paw withdrawal threshold in the von Frey hair test every other day. NMDA receptor 1 (NMDA1) and nitric oxide synthase (NOS) were measured on Day 7 after the morphine injection.@*RESULTS@#The mice hind paw withdrawal threshold in the von Frey hair test in Group 1 increased on Day 1,3, and 5 after the morphine injection compared with the paw withdrawal threshold in Group 2 and had the same threshold as Group 2 on Day 7. The mice hind paw withdrawal threshold in the von Frey hair test in Group 3 increased on Day 1,3, and 5 after the morphine injection compared with the paw withdrawal threshold in Group 4 and had the same threshold as Group 4 on Day 7. The grey scales and integral optical density (IOD) of NMDAR1 and the level of NOS in the spinal dorsal horn were higher in Group 1, Group 2, and Group 3 compared with those in Group 4 (P<0.05 or P<0.01), and the grey scales and IOD of NMDAR1 in Group 2 was higher than that in Group 1 (P<0.05).@*CONCLUSION@#NMDA receptors and NOS may play important roles in morphine tolerance in mice with bone cancer pain.
Subject(s)
Animals , Male , Mice , Bone Neoplasms , Drug Tolerance , Mice, Inbred C57BL , Morphine , Therapeutic Uses , Neoplasm Transplantation , Nitric Oxide Synthase Type I , Metabolism , Pain, Intractable , Drug Therapy , Random Allocation , Receptors, N-Methyl-D-Aspartate , Metabolism , Spinal Cord , MetabolismABSTRACT
OBJECTIVE@#To investigate the manifestation of ethology and the immunohistochemistry results of the 2B Subunits of N-methyl-D-aspartate receptors (NR2B) in the spinal cord dorsal horn and dorsal root ganglia (DRG) in mice with bone cancer pain and their correlation, and to discuss the role of NR2B in the generation and maintenance of bone cancer pain.@*METHODS@#Forty-five male C57BL/6 mice were randomly divided into 3 groups: a model group (n=15), 2×10(6) cells in 10 μL D-Hank's were injected into the left femur of mice;a sham group(n=15), only 10 μL D-Hank's injected into the left femur of mice;and a normal control group(n=15), no treatment. Spontaneous lifting duration and mechanical withdrawal threshold of the hind paw of mice were measured on alternative days throughout the experiment. Bones from 5 mice in each group were stained with HE on Day 7, 15, and 23 after the inoculation and segments of lumbar spinal cord and L(4) DRG were taken to detect NR2B by immunohistochemistry.@*RESULTS@#Bone cancer pain models were successfully established and confirmed by ethology and histology. The immunohistochemical positive indexes of NR2B were significantly higher in the model group than in the sham group and the control group. In the model group there were obvious differences either between Day 7 and Day 15, or between Day 7 and Day 23 (P<0.05). On Day 23, the immunohistochemical positive indexes of NR2B in the ipsilateral spinal cord dorsal horn of all groups, and L(4) DRG were positively correlated with the spontaneous lifting duration of ipsilateral hindpaw (r=0.976, P<0.001; r=0.882, P<0.001, respectively), negatively correlated with the mechanical withdrawal threshold of ipsilateral hindpaw (r=-0.879, P<0.001; r=-0.760, P=0.001, respectively).@*CONCLUSION@#The immunohistochemical positive indexes of NR2B are increased and significantly correlated with the manifestation of ethology. NR2B in the spinal cord and L(4) DRG may participate and mediate in forming and developing hyperalgesia in bone cancer pain.