| Purpose:To observe and compare the anesthetic and analgesic efficacy of different administration methods of esmketamine combined with thoracic paravertebral nerve block in modified radical mastectomy for breast cancer,and to further explore the application of esmketamine in anesthesia of modified radical mastectomy for breast cancer.Methods:This study was approved by the Ethics committee of our hospital,and all patients or their family members voluntarily signed informed consent.A total of 90 female patients who underwent unilateral modified radical mastectomy for the first time from December 1,2021 to June 30,2022 were selected as the research objects.The patients were divided into 3 groups according to the random number table method,with 30 cases in each group.Three groups of patients received thoracic paravertebral nerve block under the guidance of bedside ultrasound 30 min before anesthesia induction.Thoracic 2 and thoracic 5 two thoracic intervertebral space injection of 10 ml.In group C,TPVB was performed with 0.375% ropivacaine 20 ml and normal saline 10 ml was injected intravenously.Group Ⅳ: TPVB was performed with 20 ml of 0.375%ropivacaine and 10 ml of normal saline containing 0.1mg/kg esketamine intravenously.In group NB,TPVB was performed with 20 ml of 0.1mg/kg esmketamine plus 0.375% ropivacaine,and 10 ml of normal saline was injected intravenously.The same methods of anesthesia induction and maintenance were used in the three groups.After surgery,all patients were sent to the anesthesia recovery room with laryngeal mask airway.HR and MAP were monitored and recorded at the time of entering the operating room(T1),15min(T2),30min(T3),60min(T4)after completing the block,and at the end of the operation(T5);Resting and ambulatory visual analogue scale(VAS)scores were recorded at 30 min,6h,9h,12 h and 24 h after operation;The onset time and duration of sensory block after TPVB were recorded;The occurrence of adverse reactions within 24 hours after the end of surgery and the percentage of patients who used analgesics after surgery were recorded.Results:(1)There was no significant difference in general data,operation time and blood loss among the three groups(P > 0.05).(2)There was no significant difference in HR and MAP among the three groups at each time point(P > 0.05).(3)The resting and ambulatory VAS scores of the three groups were compared.The resting and ambulatory VAS scores of group Ⅳ at 6h after operation were lower than those of group C,and the difference was statistically significant(P < 0.05);The resting and ambulatory VAS scores of group NB at 6h,9h and12 h after operation were lower than those of group C,and the differences were statistically significant(P <0.05);The resting and ambulatory VAS scores of group NB were lower than those of group Ⅳ at 9h and 12 h after operation,and the differences were statistically significant(P < 0.05).(4)There was no significant difference in the onset time of sensory block among the three groups(P > 0.05);Compared with group C,the duration of sensory block was prolonged in group NB and group Ⅳ,and the difference was statistically significant(P < 0.05);The duration of sensory block in group NB was significantly longer than that in group Ⅳ(P < 0.05).(5)There was no significant difference in the incidence of adverse reactions among the three groups within 24 hours after operation(P> 0.05);There was no significant difference in the percentage of patients who needed additional analgesics after surgery among the three groups(P> 0.05).Conclusions:In modified radical mastectomy for breast cancer,both perineural injection and intravenous injection of esketamine can prolong the postoperative analgesia time of TPVB,improve the anesthetic effect of TPVB,and do not affect the hemodynamic stability of patients during operation;Compared with intravenous injection,perineural injection of esketamine has a longer analgesic time and a lower postoperative VAS score. |
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