Principle of Preoperative Anesthesia in the Surgical Treatment of Breast Cancer

Chebanov K.Bondarenko I N,Abu  Shamsiya RNovikov S., .Zavizion V,Hojouj M.Elhajj MBorodina I., Bilozorova G

KU “Dnipropetrovsk city Multidisciplinary Clinical Hospital №4» DOS

hojouj@yhaoo.com

Municipal Institution “Dnipropetrovsk City Multi-field Clinical Hospital #4″, Dnepropetrovsk state medical academy.31, Blyzhnyaya str. Dnepropetrovsk

Postoperative pain occurs after any operation, regardless of its volume. Ideal painkiller or treatment of acute postoperative pain does not exist. Solve the problem of the adequacy of postoperative analgesia allow the concept of preventive analgesia (PA) and multimodal analgesia (MMA).

The Concept of PA is at the beginning of treatment measures before surgery. Apply a non-narcotic analgesics, non-steroidal anti-inflammatory drugs, and drugs of mixed action. There do not cause depression of consciousness, hemodynamic and breathing. stabilized vegetative reactions.

The concept of MMA provides co-administration of two or more analgesics and / or treatment of pain, with different mechanisms of action to achieve adequate analgesia with minimal side effects. MMA is the method of choice for post-operative analgesia. Its basis purpose is the administration of non-opioid analgesics, which patients with pain of moderate and high intensity comply with the use of opioid analgesics and regional analgesia.

Objective: To examine the adequacy of non-narcotic analgesics anesthesia before and after radical breast surgery.

Materials and Methods: The study features perioperative analgesia 123 patients operated on for breast cancer. Average age is 43 + 2.7 years. All patients received preoperative chemotherapy. The intensity of pain was assessed by visual analogue scale (VAS) before surgery, 6-8 hours after surgery and the next morning, measured blood pressure (BP), heart rate, body temperature, oxygen saturation. Patients were divided into two groups. In the first group (57 people) – ketorolac and diclofenac was administered in the evening before the operation. In the second group (66 people) – combination of dexketoprofen and paracetamol was administered. Postoperatively, using these same drugs is on demand. Operations carried out under total intravenous anesthesia. The mean duration of operation (taking into account the duration of anesthesia) is 115 minutes.

Results: The preoperative VAS pain averaged 4.7 points without the use of analgesics. After the operation in the first group at 6-8 hours pain intensity were 6.5 on the average score in the morning – 3.7 in the second group, respectively, 2.6 and 1.8 points.

In the first group the following were noted an increase in body temperature and blood pressure, tachycardia. The second group performance did not differ significantly from baseline. Given the duration of action of drugs and intravenous routes of administration, the second group, additional analgesia postoperatively needed only at night. The average cost of drugs for analgesia in the first group 1.86 times more expensive than in the second. The postoperative hospital stays in the first group is 2.4 days more than in the second.

Conclusions: There is warning for the use of deksalgin and infulgan and MMA allows for adequate postoperative analgesia.