Effect of sub-anesthetic dose of esketamine on chronic post-surgery pain in patients undergoing radical mastectomy of breast cancer
AIM:To investigate the effect of sub-anesthetic dose of esketamine on chronic post-sur-gery pain(CPSP)in patients undergoing radical mastectomy of breast cancer.METHODS:A total of 120 patients undergoing elective radical mastecto-my of breast cancer in the operating room of our hospital from November 2021 to March 2022 were enrolled,aged 35-64 years old,and with American Society of Anesthesiologists(ASA)classification Ⅰ to Ⅱ.The subjects were allocated into esketamine group(group E)and sufentanil group(group S),with 60 subjects pergroup,according to a random number table method.At the beginning of anesthe-sia induction,patients in group E were given intra-venous injection of esketamine 0.3 mg/kg and suf-entanil 0.2 μg/kg,and during the maintenance of anesthesia,the administration rate of esketamine was 0.25 mg·kg-1·h-1,sevoflurane was continuously inhaled at 1%to 2%,and stopped 30 minutes be-fore the end of the operation,and a patient-con-trolled intravenous analgesia(PCIA)pump was con-nected immediately after the operation,and esket-amine 100 mg+sufentanil 100 μg+tropisetron 10 mg were added to the analgesia pump,supple-mented with medical 0.9%sodium chloride injec-tion to dilute to 100 mL.At the beginning of anes-thesia induction,patients in group O were intrave-nously injected with sufentanil 0.5 μg/kg,and the administration rate of remifentanil during the anes-thesia maintenance period was 0.1-0.3 μg·kg-1·min-1,and stopped 5 minutes before the end of the operation.Sufentanil 150 μg+tropisetron 10 mg was added to the PCIA pump,supplemented with medical 0.9%sodium chloride injection to dilute to 100 mL.The PICA pump parameters in both groups were set to background dose of 2 mL/h,bolus dose was 0.5 mL,and locked time was 15 min.The main outcome was the incidence of CPSP on postopera-tive 3 months,and the patients were followed up at 3 and 6 months postoperatively to record the oc-currence of CPSP.The secondary outcomes were vi-sual analogue scale of pain(VAS),Ramsay sedation scale and the incidence of postoperative adverse events within 48 hours after surgery.Peripheral ve-nous blood was drawn 1 day before operation and 1 day and 3 days after operation,and the concen-trations of serum inflammatory factors including tu-mor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were measured.RESULTS:There were 2 lost patients in group S and 3 lost pa-tients in group E.At 3 and 6 months after opera-tion,27(46.6%)and 19(32.8%)patients in group S had CPSP,including 18(31.0%)and 13(22.4%)pa-tients with mild pain,respectively.13(22.8%)and 8(14.0%)patients in group E had CPSP,including 8(14.0%)and 5(8.8%)patients with mild pain,re-spectively.The incidence of CPSP in group E was lower than that in group S at 3 and 6 months after operation(P<0.05).The VAS scores and Ramsay se-dation scores of the two groups of patients were similar at different time points after operation with-in48h(P>0.05).The analgesic rescue rate within 2 days after operation,the total number of PCIA pump compressions and the number of effective compressions were not similar between the two groups,and there was no statistical significance(P>0.05).Compared with group S,the incidence of nausea and vomiting in group E was significantly lower within 2 days after operation(P<0.05).The serum levels of TNF-α,IL-6 and IL-8 in the group E were significantly decreased on postoperative 1 and 3 d,compared with group S(P<0.05).CONCLU-SION:Sub-anesthetic dose of esketamine can inhib-it perioperative inflammatory response and lower the incidence of CPSP in patients undergoing breast cancer surgery.
esketaminechronic post-surgery painradical mastectomy of breast cancerinflam-mation
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