Postoperative effect of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients

Patients and grouping

One hundred and twelve female patients who voluntarily requested breast cancer surgery were selected from the Affiliated Hospital of Guilin Medical University between January 2015 and January 2017. The surgery of all patients was performed by the same surgeon. All patients were informed with the study and wrote the consent. This study was approved by the Ethical Boards of the Affiliated Hospital of Guilin Medical University and the registration number is 2022QTLL-09.

Inclusion criteria for patient selecting: (1) Underwent unilateral radical surgery of breast cancer; (2) Had no metastasis of breast cancer; (3) Aged 18–80 years old; (4) At I-II level of American Society of Anesthesiologists Classification.

Exclusion criteria for patient selecting: (1) Had hypertension, diabetes, cardiopulmonary, hepatic or renal diseases, or disorders of water-electrolyte balance; (2) Had history of relevant drug allergies, history of opioid or alcohol abuse, history of taking antidepressants and psychological drugs, or history of chronic pain; (3) Had addiction to opiates or psychedelic drugs; (4) Had history of taking analgesics and NSAIDs in the 48 h before surgery; (5) Had speech, hearing, vision or other severe psychological disorders that do not cooperate with perioperative psychological support therapy.

The patients were divided into four groups and there were 28 patients in each group. Patients in group A were given sufentanil preemptive analgesia combined with psychological intervention, patients in group B had only sufentanil preemptive analgesia, patients in group C had only perioperative psychological support therapy (PPST), and patients in group D were under general anesthesia with conventional intubation.

Perioperative psychological support therapy (PPST)

At the day before the surgery, face-to-face communication and routine visits were given to allow patients sign the informed consent for anesthesia and get psychological interventions. The exact procedures were as follows:

1) Cognitive input: giving photos of people wearing surgical gowns and scenes related to work in the operating room, introducing the basic process of entering the operating room on the day of surgery and the basic steps of general anesthesia; helping patients to have a correct perception of anesthesia with the help of popular science articles as well as videos and pictures.

2) Anxiety self-assessment scale: to understand their level of stress and anxiety, the reasons, and individualized analysis to help.

3) Cue therapy: confident and assertive attitude of the anesthesiologist informing about the method of anesthesia, contingency plans, and safety.

4) Successful case desensitization: using the cases of successful postoperative patients to remove patients’ fears and increase their confidence.

5) Postoperative follow-up on analgesic satisfaction and related psychological conditions of breast cancer patients after surgery.

Analgesia methods

Group A: Anesthesiologists explained the purpose of tracheal intubation to patients 30 min before surgery, showed and acquainted patients with the tracheal tube, and instructed patients in advance to open their mouths to simulate postoperative cooperation with tracheal extubation. Then the patients were given 10 µg sufentanil (diluted to 10 mL with saline) by intravenous injection, and PPST by professional staff according to standard procedures.

Group B: Patients were given 10 µg of sufentanil (diluted to 10 mL with saline) intravenously 30 min before surgery.

Group C: Patients were explained the purpose of tracheal intubation 30 min before surgery, shown and acquainted with the tracheal tube, and instructed in advance to open their mouths to simulate postoperative cooperation with tracheal extubation, followed by intravenous injection of 10 mL saline.

Group D: Patients received conventional intubation with general anesthesia, without any preemptive analgesia or psychological support treatment.

Anesthesia methods

All breast cancer patients were intubated with general anesthesia, routinely abstained from drinking for 6 h and from eating for 8 h before surgery. One vein was opened after the patient was admitted to the room. Before the start of the surgery, all patients were intravenously injected with 0.07 mg/kg midazolam, 0.2 mg/kg etomidate, 0.5 µg/kg sufentanil and 0.7 mg/kg rocuronium. After entering anesthesia, patients were maintained by sedation with 4–10 mg/(kg•h) propofol + 1% sevoflurane, analgesia with 0.05–0.25 µg/(kg•min) remifentanil, muscle relaxation with 0.3–0.6 mg/kg rocuronium maintenance, and muscle relaxants were stopped 35 min before the end of surgery. The target-controlled concentration of propofol, remifentanil and rocuronium was adjusted at any time during the operation according to the patient’s body movement response, the change of heart rhythm, and blood pressure until the end of the operation. Propofol and remifentanil were stopped at the end of the operation in all four groups, and 20 µg/kg neostigmine and 10 µg/kg atropine were administered to antagonize the residual effect of muscle relaxants. All patients were given 3 mg granisetron IV at the end of surgery and appropriate intraoperative fluid rehydration according to the situation, and the tracheal tube was removed after the patients had the conditions for extubation at the end of surgery.

Analgesic evaluation

Visual Analogue Scale/Score (VAS) is used for analgesic evaluation. VAS is divided into a linear graph with a 10 cm × 3 cm linear scale, where “0” on the left side indicates no pain and “10” on the right side indicates the most severe pain imaginable. The pain scores of the four groups were compared at 2, 12 and 24 h after surgery. The time of surgery, time of awakening and time of extubation were recorded for the four groups. The patients were observed for complications such as respiratory depression, cardiac arrhythmia, and gastrointestinal bleeding. The use of other analgesics on demand, and the occurrence of nausea, vomiting, sleepiness and pruritus were recorded in the 24 h postoperative period.

Statistical analyses

G*Power 3.1.9.7 software was used for sample size calculation. According to our pre-experiment, the effect size was set at 0.4 which is a large Cohen’s univariate effect size convention, the test level was set at 0.05, and the test power was 0.90. The total sample size was 93. Considering the loss to follow-up, 112 patients were collected. SPSS 23.0 was applied to analyze all the data. Mean ± standard deviation (SD) was used for the quantitative data. One-way ANOVA was used for the comparison of the four groups, SNK test was used for the comparison between two groups, and repeated-measures ANOVA was used for the repeated-measures data. For the qualitative data, chi-square test was used for the comparison between groups. Differences were considered statistically significant at P < 0.05.

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