艾司氯胺酮联合前锯肌平面阻滞对乳腺癌改良根治术后镇痛的影响

Effect of esketamine combined with serratus anterior plane block on postoperativeanalgesia after modified radical mastectomy for breast cancer

目的 探讨艾司氯胺酮联合前锯肌平面阻滞(SAPB)对乳腺癌改良根治术患者术后镇痛及焦虑抑郁情绪的影响。方法 选取宿迁市第一人民医院2023年1月至2024年1月乳腺癌改良根治术患者96例,按随机数字表法分为3组(n=32):艾司氯胺酮联合SAPB组(KS组)、SAPB组(S组)、空白对照组(C组)。KS组在全身麻醉诱导后行患侧SAPB,在切皮前缓慢静脉注射0.25 mg/kg艾司氯胺酮,术中持续泵注剂量为0.12 mg/(kg·h),手术结束前30 min停药;S组在全身麻醉诱导后行患侧SAPB;C组实施全身麻醉。S组和C组在麻醉诱导后和术中给予KS组同等剂量生理盐水。记录患者术后2、6、12、24 h的静息/运动视觉模拟评分(VAS);记录患者术前1 d、术后3 d及术后1周医院焦虑抑郁量表(HADS)评分;记录患者术后48 h内镇痛泵的按压次数和不良反应发生情况。结果 与C组相比,KS组和S组在术后6、12 h静息/运动VAS评分降低,术后48 h内镇痛泵的按压次数较少(P<0.05);与C组和S组相比,KS组术后12 h运动VAS评分较低(P<0.05),术后3 d、1周的HADS评分低(P<0.05),术后失眠发生率低(KS组为0, S组为19.4%, C组为22.6%,P=0.008);其他不良反应比较差异无统计学意义(P>0.05)。结论 在乳腺癌改良根治术中,艾司氯胺酮联合SAPB可减轻患者术后的急性疼痛,缓解患者焦虑抑郁情绪,且不增加术后不良反应。

Objective To explore the effects of esketamine combined with serratus anterior plane block(SAPB)on postoperative analgesia,anxiety and depression in patients with breast cancer undergoing modified radical mastectomy.Methods From January 2023 to January 2024,96 patients with breast cancer underwent modified radical mastectomy in Suqian First Hospital were selected and randomly divided into three groups(n=32):esketamine combined with SAPB group(KS group),SAPB group(S group),and blank control group(C group).The KS group underwent SABP on the affected side after induction of general anesthesia,0.25 mg/kg of esketamine was slowly injected intravenously before skin incision,with a continuous infusion dose of 0.12 mg·kg^(-1)·h^(-1) during surgery.The medication was stopped 30 minutes before the end of the surgery;S group underwent SABP on the affected side after induction of general anesthesia;C group received general anesthesia.The S group and C group were given the same dose of normal saline to the KS group after anesthesia induction and during surgery.The resting/exercise visual analogue scale(VAS)scores of patients at 2,6,12,24 hours post-surgery and the hospital anxiety and depression scale(HADS)for patients 1 day before surgery,3 days after surgery,and 1 week after surgery were recorded.The number of compressions of the analgesic pump and the occurrence of adverse reactions within 48 hours after surgery were compared.Results Compared with C group,KS and S groups had lower resting/exercise VAS scores at 6 and 12 hours postoperatively,and fewer number of compressions of the analgesic pump within 48 hours postoperatively(P<0.05).Compared with C group and S group,the KS group had lower exercise VAS scores at 12 hours post-surgery and HADS scores at 3 days and 1 week post-surgery(P<0.05),as well as a lower incidence rate of insomnia within 48 hours post-surgery(KS group 0,S group 19.4%,C group 22.6%,P<0.05).However,there was no statistically significant incidence of adverse reactions among three groups(P>0.05).Conclusion In the modified radical mastectomy for breast cancer,esketamine combined with SAPB can reduce the acute postoperative pain,alleviate the anxiety and depression of patients,and do not increase the adverse reactions after the operation.