Effects of esketamine used for patient-controlled intravenous analgesia on chronic postoperative pain in elderly patients undergoing thoracic surgery
AIM To investigate the effects of esketamine used for patient-controlled intravenous analgesia(PCIA)on chronic postsurgical pain(CPSP)in elderly patients undergoing thoracic surgical procedures.METHODS A total of 120 elderly patients scheduled for video-assisted thoracoscopic radical resection of lung cancer were randomly divided equally into control group and trial group,with the same anesthesia induction and maintenance protocols in both groups.All patients were immediately connected to the PCIA pump after surgery.The analgesic drugs of the control group were sufentanil 1.0 μg·kg-1+flurbiprofen axetil 2.0 mg·kg-1+tropisetron 10 mg,and of the trial group were esketamine 2.0 mg·kg-1+flurbiprofen axetil 2.0 mg·kg-1+tropisetron 10 mg,which were both diluted to 100 mL with sodium chloride injection,and the parameters of the PICA pump in the both groups were the same.The pain visual analogue scale(VAS)score and Ramsay sedation score was recorded within 48 hours after surgery,as well as the occurrence of adverse reactions.The concentrations of serum tumor necrosis factor(TNF)-α,interleukin(IL)-6 and IL-8 on preoperative 1 d and postoperative 1 d and 3 d were measured.Telephone follow-up was conducted 3 to 6 months after surgery to record the occurrence of CPSP.RESULTS There was no significant difference in the VAS score,Ramsay sedation score,the rate of analgesic rescue,the total number of compression and the number of effective compression of PCIA pump between the two groups within 48 hours after surgery(P＞0.05).The incidence of nausea and vomiting in the trial group was significantly lower than that in the control group within 48h after operation(P＜0.05).Compared with preoperative 1 d,the concentrations of serum TNF-α,IL-6 and IL-8 in the two groups were significantly increased(P＜0.05)on postoperative 1 d and 3 d,but the concentrations of serum TNF-α,IL-6 and IL-8 in the trial group were significantly lower than those in the control group(P＜0.05).Within 6 months after surgery,there were 2 cases of lost follow-up in the control group and 3 cases of lost follow-up in the trial group.At 3 months after surgery,CPSP occurred in 18 cases(31％)of the control group and 7 cases(12％)of the trial group,respectively(P＜0.05).At 6 months after surgery,CPSP occurred in 15 cases(26％)of the control group and 5 cases(9％)of the trial group,with significant differences between the two groups(P＜0.05).CONCLUSION Esketamine for PCIA can reduce the incidence of CPSP in elderly patients undergoing thoracic surgery,which may be related to the inhibition of inflammatory response.
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