The Effect Of Esketamine On Perioperative Analgesia And Antidepressant Effects In Breast Cancer Patients

Objective:To observe the effects of the perioperative application of esketamine in breast cancer patients on postoperative analgesia,depression scores and serum concentrations of BDNF and DA,and to preliminarily investigate the optimal administration mode and dose of esketamine for use in the perioperative period in breast cancer patients.Methods:1.90 patients undergoing modified radical unilateral breast cancer surgery under general anesthesia from October 2021 to April 2022 were selected.By using a random number table,patients will be randomised into three groups: Group K1(intraoperative drug administration group),Group K2(intraoperative and postoperative drug administration group)and Group C(control group),each with a number of 30 patients.2.After admission to the room and opening of intravenous access,group K1 was given 0.2 mg/kg esketamine after induction of conventional anaesthesia;group K2 was given 0.2 mg/kg esketamine after induction of conventional anaesthesia and 0.5 mg/kg esketamine was added to the postoperative PCIA;group C was given the same dose of saline.3.Recorded separately.(1)Hamilton Depression Scale-17(HAMD-17)scores 1 day before and7 days after surgery in the three groups.(2)Dopamine(DA)and serum Brain-derived Neurotrophic Factor(BDNF)levels on the first day before and the first day after surgery in the three groups.(3)Visual Analogue Scale(VAS)at 1 day,3 days and 7 days after surgery in the three groups.(4)The number of PCIA self-control and the occurrence of adverse effects including nausea,vomiting,headache,vertigo,hallucinations,drowsiness,diplopia,myalgias and pruritus were recorded in the three groups at 24 hours postoperatively.Results:1.1 day before surgery,there was no statistically significant difference in HAMD scores between the three groups(p>0.05).At 7 days after surgery,the HAMD score in group K1 was significantly lower compared to group C.The difference was statistically significant(P<0.05);the HAMD score in group K2 was significantly lower compared to group K1.2.The difference in BDNF and DA levels between the three groups was not statistically significant(P>0.05)on the first day before surgery.On the first day after surgery,the BNDF level in group K1 was significantly higher compared with group C,and the difference was statistically significant(P<0.05);compared with group K1,the BNDF level in group K2 was significantly higher,and the difference was statistically significant(P<0.05).The difference in DA levels between the three groups was not statistically significant at 1 day postoperatively(P>0.05).3.1 day after surgery,the VAS score in group K2 was significantly lower than that in groups C and K1,and the difference was statistically significant(P<0.05);compared with group C,the difference in VAS score in group K1 was not statistically significant.The difference in VAS scores between the three groups at 3 and 7 days after surgery was not statistically significant(P>0.05).4.There was no statistically significant difference between the three groups in terms of the number of 24-hour PCIA self-control,operation time,bleeding,extubation time and discharge time(P>0.05).5.There were no hallucinations,diplopia,myalgias and pruritus in any of the three groups.There was no significant difference between the three groups in terms of postoperative adverse effects(P>0.05).Conclusions:The application of low-dose esketamine in the perioperative period of breast cancer patients is effective,which can effectively improve the postoperative depression of patients,improve the postoperative analgesic effect,and will not increase adverse reactions.