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

Abstract

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〖LM〗 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.

Keywords

• esketamine， serratus anterior plane block， anaesthesia， breast cancer， anxiety， depression