Pooperační analgezie při operacích karcinomu prsu – anestetické techniky a role cytokinů

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Autoři: Paula Borela Perfeito Abud ¹ ; Flora Margarida Barra Bizinoto ¹ ; Natália Nunes Santos ¹ ; Letícia Tereza Dornelas de Melo ¹ ; Rafaela Barcelos Andrade ¹ ; Bruno Henrique Gomes Parizzi ² ; Millena Prata Jammal ² ; Douglas Côbo Micheli ² ; Eddie Fernando Candido Murta ² ; Rosekeila Simões Nomelini ^2,3
Působiště autorů: Federal University of Triângulo Mineiro, Uberaba – MG, Brazil ; Discipline of Anesthesiology/ Department of Surgery/Federal University of Triângulo Mineiro, Uberaba – MG, Brazil ¹; Laboratory of Applied Sciences for Women (LaCam)/ Department of Gynecology and Obstetrics ²; Graduate Program in Gynecology and Obstetrics of the Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil ³
Vyšlo v časopise: Ceska Gynekol 2025; 90(6): 447-456
Kategorie: Původní práce
doi: https://doi.org/10.48095/cccg2025447

Souhrn

Cíle: Zkoumat vztahy mezi pooperační bolestí, anesteziologickou technikou a použitím analgetik, porovnat předoperační a pooperační hladiny cytokinů v séru a určit vliv anesteziologické techniky na tyto hladiny u pacientek podstupujících operaci rakoviny prsu. Materiály a metody: Celkem 36 pacientek podstupujících onkologickou operaci prsu bylo rozděleno do skupin pouze s celkovou anestezií (G; n = 20) a s celkovou anestezií ESPBE (erector spinae plane block, E; n = 16). Intenzita pooperační bolesti byla hodnocena pomocí vizuální analogové stupnice ve třech okamžicích (M): 2, 24 a 48 hod po ukončení operace (M2, M24 a M48). Krev byla odebrána před operací, před indukcí celkové anestezie (M0) a v M24 a M48. Hladiny plazmatického interleukinu (IL) -1, IL-8 a tumor nekrotizujícího faktoru a (TNF-a) byly stanoveny pomocí enzymově vázaného imunosorbentního testu. Souvislosti mezi kategoriálními proměnnými byly hodnoceny pomocí Fisherova exaktního testu. Skóre bolesti a hladiny cytokinů byly porovnány mezi skupinami G a E a mezi pacientkami podstupujícími mastektomii a kvadrantektomii pomocí analýzy rozptylu s opakovanými měřeními. Hladina významnosti použitá pro všechny testy byla 5,0 %. Výsledky: Středně silná až silná bolest byla častější ve skupině G než ve skupině E v M24 (p = 0,016). Hladina IL-8 byla ve skupině E nižší než ve skupině G (p = 0,029). V celé kohortě byla hladina TNFa snížena v M48 (p = 0,010), hladina IL-8 byla snížena v M24 (p < 0,001) a hladina IL-1 byla zvýšena v M48 (p < 0,001). Závěry: ESPB je účinnou alternativou v případech s kontraindikacemi nebo technickými obtížemi s jinými anestetickými technikami, jako je epidurální anestezie. Jeho použití by mohlo zlepšit kvalitu života a zdraví žen po operaci rakoviny prsu.

Klíčová slova:

cytokiny – mastektomie – celková anestezie – segmentální mastektomie – neuromuskulární blokáda

Zdroje

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ORCID of authors

P. B. Perfeito Abud 0009-0002-2270-3260

F. M. Barra Bizinoto 0000-0002-5620-8615

N. Nunes Santos 0009-0008-0523-606X

L. T. Dornelas de Melo 0009-0004-4436-6298

R. Barcelos Andrade 0009-0009-5643-4215

B. H. Gomes Parizzi 0000-0002-8922-1103

M. Prata Jammal 0000-0003-2693-8817

D. Côbo Micheli 0009-0001-1618-1470

E. F. Candido Murta 0000-0003-4014-1345

R. Simões Nomelini 0000-0001-6591-7619

Submitted/Doručeno: 25. 3. 2025