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Effect of Dezocine on the Ratio of Th1/Th2 Cytokines in Patients

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Effect of Dezocine on the Ratio of Th1/Th2 Cytokines in Patients Drug Design, Development and Therapy Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Effect of Dezocine on the Ratio of Th1/Th2 Cytokines in Patients Receiving Postoperative Analgesia Following Laparoscopic Radical Gastrectomy: A Prospective Randomised Study Man Feng1 Purpose: To evaluate the effect of dezocine on the postoperative ratio of Th1/Th2 cytokines Qinli Feng2 in patients undergoing laparoscopic radical gastrectomy. Yujie Chen3 Patients and Methods: Sixty patients undergoing laparoscopic radical gastrectomy were Ge Liu 2 randomly divided into two groups (n=30): dezocine group (Group D) and sufentanil group Zhuanglei Gao4 (Group S). They received patient-controlled intravenous analgesia (PCIA) after the operation with either dezocine 0.8 mg/kg (Group D) or sufentanil 2 µg/kg (Group S). Both groups also Juan Xiao5 received ondansetron 8 mg diluted to 100 mL with saline. The primary outcome was the Th1/ Chang Feng 2 Th2 cytokines ratio at predetermined intervals, 30 min before the induction of general 1Department of Pathology, Affiliated anaesthesia and 0, 12, 24 and 48 h after surgery. The secondary endpoints were patients’ Hospital of Shandong Academy of pain scores, measured on a visual analogue scale (VAS) at predetermined intervals (0, 12, 24 Medical Sciences, Shandong First Medical University, Jinan, 250000, People’s and 48 h after surgery), and side effects at follow-up 48 h after surgery. 2 Republic of China; Department of Results: The Th1/Th2 cytokines ratio in Group D was significantly higher than Group Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong S (P<0.05) 12, 24 and 48 h after the operation. There were no significant differences in VAS University, Jinan, 250033, People's pain scores between groups at 0, 12, 24 and 48 h after surgery (P>0.05). Compared to Group 3 Republic of China; Department of S, the incidence of postoperative nausea, vomiting and lethargy was significantly lower in Anesthesiology, Affiliated Hospital of Shandong of TCM, Jinan, 250001, Group D (P<0.05). People's Republic of China; 4Department Conclusion: Dezocine increases the ratio of Th1/Th2 cytokines, relieves postoperative pain of General Surgery, The Second Hospital, and causes fewer side effects in patients undergoing laparoscopic radical gastrectomy. Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Keywords: dezocine, gastric cancer, laparoscopic radical operation, postoperative analgesia, Republic of China; 5Department of Th1/Th2 cytokines Center of Evidence-Based Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China Introduction Laparoscopic radical gastrectomy has become the preferred treatment for gastric cancer due to its advantages over traditional open procedures, including reduced trauma, less bleeding and faster recovery.1 However, moderate to severe postoperative pain can cause a strong stress response in patients, leading to decreased immune function and a greater risk of postoperative tumour recurrence and metastasis.2–4 Correspondence: Chang Feng Department of Anesthesiology, The Postoperative analgesia management is closely related to postoperative recovery, Second Hospital, Cheeloo College of and some studies suggest that it is associated with the long-term prognosis of tumors.5 Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s T helper (Th) lymphocytes play an important role in antitumour immunity. An imbal­ Republic of China ance of Th cells is related to metastasis and recurrence of malignant gastrointestinal Tel +86-17660085521 6 Email [email protected] tumours, especially adecreasedTh1/Th2 ratio. Multiple studies have shown that Drug Design, Development and Therapy 2021:15 2289–2297 2289 © 2021 Feng et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Feng et al Dovepress scientific and rational selection of postoperative analgesics trial. The major exclusion criteria were as follows: pre­ can effectively relieve pain and reduce stress, perioperative operative cognitive dysfunction; history of severe hyper­ complications and interference with the patient’s immune tension or heart disease; severe respiratory disease; system and tumour cells, which directly and indirectly affect immune system disease; endocrine system disease; blood the prognosis.7,8 A good postoperative analgesic effect can system disease; acute or chronic infectious disease; hepatic improve the immunosuppressive state of the patient, promot­ or renal dysfunction; recent antidepressant, sedative, ing the differentiation and balance of Th cells and helping to analgesic or glucocorticoid use; allergy to the drugs used maintain the balance of cellular immunity and humoral in the study; recent history of radiotherapy, chemotherapy immunity.7–11 or immunosuppressant application; perioperative blood The most commonly used opioid analgesic in patient- transfusion; past history of abdominal surgery; transferred controlled intravenous analgesia (PCIA) is sufentanil;11 to open surgery; required reoperation or infection within however, it’s the adverse reactions associated with this 48 h after operation; failure to complete data collection; drug are serious, and studies have shown that it inhibits and refusal to participate in the study. Patients were ran­ immune function.10,12,13 As a new potent synthetic opioid domly assigned in a blinded fashion (using a sealed opa­ analgesic, dezocine is mostly used for moderate to severe que envelope system) to the dezocine group (Group D) or analgesia. It is characterised by complete activation of the the sufentanil group (Group S). Before the study proce­ κ receptor, spinal cord analgesia, mild sedation and dure, all patients received training on how to use the PCIA respiratory depression. It is a μ receptor antagonist, so it pump over the 48-h postoperative follow-up period and presents a smaller risk of addiction.14,15 In addition, the how to use the 10-cm visual analogue scale (VAS) to latest research shows that dezocine can regulate immune record pain (from 0, no pain, to 10, the worst imaginable function by affecting the activity of NK cells, CD4+ cells, pain). They were all encouraged to press the analgesia CD8+ cells and dendritic cells.13,16,17 However, the effect pump during the preoperative education session and post­ of dezocine on Th cell differentiation remains unclear. operative follow-up periods. All patients fasted for at least Therefore, this study aimed to investigate the effect of 12 h before the procedure, and no premedication was dezocine on the ratio of Th1/Th2 cytokines in patients administered before anaesthesia. Following their arrival receiving postoperative analgesia following laparoscopic in the operation room, patients received standard ASA radical gastrectomy and provide a more reliable basis for and bispectral index (BIS) monitoring throughout the pro­ perioperative analgesia of tumour patients. cedure. All patients received completely intravenous anaesthesia and mechanical ventilation. Anaesthesia was Materials and Methods induced with 1.5–3.0 mg/kg of propofol, 0.3 µg/kg of sufentanil and 0.6 mg/kg of rocuronium. Anaesthesia was Patients maintenance was performed with a continuous intravenous The institutional Research Ethics Board approved the infusion of 3–10 mg/kg/h of propofol and 0.05–0.2 µg/kg/ study protocol (KYLW-2019LW28) for this prospective, min of remifentanil. During surgery, heart rate (HR) was randomised, double-blind clinical trial. The study was maintained at 60–100 beats/min, mean arterial pressure registered at the Chinese Clinical Trial Registry (http:// (MAP) was kept within ±20% of the baseline value, www.chictr.org.cn; ID: ChiCTR2000033754) on June 11, saturation of peripheral oxygen (SPO2) was 98–100%, 2020. The authors adhered to the Consolidated Standards end-tidal carbon dioxide (ETCO2) was 35–45 mmHg, of Reporting Trials (CONSORT) guidelines for reporting and BIS was 40–60. Patients were given ondansetron randomised controlled trials. 4 mg intravenously 10 min before the skin incision, sup­ plemented with sufentanil 0.3 µg/kg. Rocuronium or Study Protocol vasoactive agents were administered as appropriate during After providing written informed consent, 60 patients clas­ the procedure. Propofol and remifentanil were stopped 15 sified as American Society of Anesthesiologists (ASA) min before the end of the operation, and no antagonist was physical status class I or II, aged 30–60 years and sched­ used. After the patient’s steward score (0–6 points, ranging uled for laparoscopic radical gastrectomy between July from an unresponsive, immobile patient whose airway and December 2020 in the Second Hospital of Shandong requires maintenance to a fully recovered patient) was University were considered eligible to participate in the greater than 6 points, the tracheal tube was removed,
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