title: A Comparison of Fentanyl and Flurbiprofen Axetil on Serum VEGF-C, TNF-α, and IL-1ß Concentrations in Women Undergoing Surgery for Breast Cancer.
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).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Yiyun
authors.initials: Y
authors.lastname: Wen
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Mingde
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of ICU, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Yichun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Huiping
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Jianghong
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Weizhen
authors.initials: W
authors.lastname: Liu
authors.affiliation: The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Hongwu
authors.initials: H
authors.lastname: Deng
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami - Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Catalina
authors.initials: C
authors.lastname: Castillo-Pedraza
authors.affiliation: The Care Central of Breast Cancer, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami - Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000097:blood / Q000601:surgery; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D005480:Flurbiprofen / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D053583:Interleukin-1beta / Q000097:blood* / Q000187:drug effects; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000097:blood* / Q000187:drug effects; D042582:Vascular Endothelial Growth Factor C / Q000097:blood* / Q000187:drug effects
chemical_list: D000700:Analgesics; D053583:Interleukin-1beta; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D042582:Vascular Endothelial Growth Factor C; D005480:Flurbiprofen; C504422:flurbiprofen axetil; D005283:Fentanyl
keywords: analgesia; immunologic factors; postoperative pain