Effect of pre-emptive analgesia with flurbiprofen axetil and tramadol on lymphocyte counts in patients of breast cancer

Background and purpose:It is widely accepted that pre-emptive analgesia has great effects on alleviation of postoperative pain, while pre-emptive analgesic effect on immune system has not been well studied. In this study, we evaluated the effect of pre-emptive analgesia of flurbiprofen axetil and tramadol on lymphocyte counts in patients of breast cancer. Methods:In this prospective randomized, double-blind, placebo-controlled study, eighty patients were randomly assigned to one of four groups (n=20).Fifteen min before tracheal intubation,the FA group (group A) received iv flurbiprofen axetil 1 mg/kg, the tramadol group (group B) received iv tramadol 1 mg/kg, the control group (group C) received iv saline 20 ml, the combination group (group D) received iv flurbiprofen axetil 0.5 mg/kg and tramadol 0.5 mg/kg. At the end of surgery, the FA group (group A) patients received iv flurbiprofen axetil 0.5 mg/kg, the tramadol group (group B) patients received iv tramadol 0.5 mg/kg, the control group (group C) patients received iv saline 20 ml, the combination group (group D) patients received iv flurbiprofen axetil 0.25 mg/kg and tramadol 0.25 mg/ kg. Peripheral venous blood samples were collected 30 min before tracheal intubation(T0), 30 min postoperatively(T0.5), 4 hrs postoperatively(T4),24 hrs postoperatively(T24) for the determination of CD3+, CD4+, CD8+ and lymphocyte and measured by flow cytometry. Results:The characteristics of the patients in four groups were similar in terms ofage, body mass index (BMI), anesthesia time and operation time. There were no significant differences in CD3+, CD4+, CD8+ and lymphocytes at T0 among four groups. The CD3+, CD4+, CD8+ and lymphocytes decreased at T0.5, T4 , T24 as compared to those at T0 of group C (P0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 as compared to those at T0.5 of group C (P0.05). The CD3+, CD4+, CD8+ and lymphocytes increased at T24 as compared to those at T4 but decreased at T24 than those at T0.5 of group C (P0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 , T24 as compared to those at T0 of group A and D (P0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T0.5, T4 , T24 as compared to those at T0 of group B (P0.05). The CD3+, CD4+, CD8+ and lymphocytes decreased at T4 as compared to those at T0.5 of group B (P0.05). There were no significant differences in CD3+, CD4+, CD8+ and lymphocytes between T0.5 and T24 of group B. The CD3+, CD4+, CD8+ and lymphocytes of group D were higher than those of group C at T0.5 and T4 (P0.05). Conclusion:Pre-emptive analgesia of flurbiprofen axetil and tramadol has a positive effect on alleviating immunosuppression induced by surgery and anesthesia, thus it also protects the immune system in patients with breast cancer.