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A Comparison of Fentanyl and Flurbiprofen Axetil on Serum VEGF-C, TNF-α, and IL-1ß Concentrations in Women Undergoing Surgery for Breast Cancer

Authors

  • Yiyun Wen MD,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Mingde Wang BA,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Jinfeng Yang MD PhD,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Yichun Wang PhD,

    1. Department of ICU, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Huiping Sun MD,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Jianghong Zhao MD,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Weizhen Liu MD,

    1. Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Zhengyu Zhou MD,

    1. The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Hongwu Deng MD,

    1. The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Catalina Castillo-Pedraza MD,

    1. Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami - Miller School of Medicine, Miami, Florida, U.S.A
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  • Yi Zhang MD,

    1. The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
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  • Keith A. Candiotti MD

    Corresponding author
    1. Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami - Miller School of Medicine, Miami, Florida, U.S.A
    • Address correspondence and reprint requests to: Keith Candiotti, MD, Department of Anesthesiology, University of Miami - Miller School of Medicine, 1611 Northwest 12th Avenue, Central 130(R-370), Miami, Florida 33136, U.S.A. E-mail:KCandiot@med.miami.edu.

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Abstract

Background

Vascular endothelial growth factor-C (VEGF-C), tumor necrosis factor-α (TNF-α), and interleukin-1ß(IL-1ß) have been shown to be associated with the recurrence and metastasis of breast cancer after surgery. This study tested the hypothesis that patients undergoing surgery for breast cancer, who received postoperative analgesia with flurbiprofen axetil combined with small doses of fentanyl (FA), exhibited reduced levels of VEGF-C, TNF-α, and IL-1ß compared with those patients receiving fentanyl alone (F).

Method

Forty-women with primary breast cancer undergoing a modified radical mastectomy were randomized to receive postoperative analgesia with flurbiprofen axetil combined with fentanyl or fentanyl alone. Venous blood was sampled before anesthesia, at the end of surgery, and at 48 hours after surgery, and the serum was analyzed. The primary endpoint was changes in the VEGF-C concentrations in serum.

Results

Group FA patients reported similar analgesic effects as group F patients at 2, 24, and 48 hours. At 48 hours, mean postoperative concentrations of VEGF-C in group F patients were higher than in group FA patients, 730.9 versus. 354.1 pg/mL (P = 0.003), respectively. The mean postoperative concentrations of TNF-α in group F patients were also higher compared with group FA patients 27.1 vs. 15.8 pg/mL (P = 0.005). Finally, the mean postoperative concentrations of IL-1ß in group F were also significantly higher than in group FA 497.5 vs. 197.7 pg/mL (P = 0.001).

Conclusion

In patients undergoing a mastectomy, postoperative analgesia with flurbiprofen axetil, combined with fentanyl, were associated with decreases in serum concentrations of VEGF-C, TNF-α, and IL-1ß compared with patients receiving doses of only fentanyl.

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