亚麻醉剂量艾司氯胺酮减轻乳腺和甲状腺手术患者术后疼痛和焦虑的随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：王婷婷          编辑：王波          审校：曹莹


背景
背景jbhb

术后疼痛和焦虑影响患者的康复，增加家庭负担。艾司氯胺酮在临床上具有镇痛和抗抑郁作用。亚麻醉剂量的艾司氯胺酮对术后疼痛和焦虑的影响仍有待澄清。

方法


将120例接受乳腺或甲状腺手术的患者按手术类型分层，以1：1的比例随机分配至艾司氯胺酮组和对照组。麻醉诱导后给予艾司氯胺酮（0.3 mg/kg）或等体积生理盐水。分别于术前、术后第1、2、3天进行疼痛视觉模拟评分（VAS）和焦虑自评量表（SAS）评分。比较两组患者术后VAS评分和SAS评分，并对影响术后中重度疼痛的危险因素进行Logistic回归分析。

结果


术中艾司氯胺酮降低了术后第1、2和3天的VAS和SAS评分（P < 0.05，重复测量的双因素ANOVA（方差分析），然后进行Bonferroni事后分析（多重检验矫正分析））。亚组分析显示，艾司氯胺酮降低了乳腺手术和甲状腺手术患者术后第1、2和3天的VAS和SAS评分。Logistic回归分析显示氯胺酮和规律运动是术后中重度疼痛的保护因素，术前焦虑是术后中重度疼痛的危险因素（P < 0.05）。

【罂粟摘要】

结论


      术中亚麻醉剂量的艾司氯胺酮可降低术后疼痛程度与焦虑程度，术前焦虑是术后疼痛的危险因素，而艾司氯胺酮与规律运动是术后疼痛的保护因素。

原始文献来源：Zhou D, Liu F, Jiang F, Ye X, Gong X, Zhang M. Sub-Anesthesia Dose of S-Ketamine Reduces Postoperative Pain and Anxiety in Patients Receiving Breast and Thyroid Surgery: A Randomized, Controlled Trial. Pain Physician. 2023;26(3):257-264.

Sub-AnesthesiaDoseof S-Ketamine ReducesPostoperative Pain and Anxiety in PatientsReceiving Breast and Thyroid Surgery: ARandomized, Controlled Trial

Background: Postoperative pain and anxiety affect patients’ recovery and increase the familyburden. S-ketamine presents analgesic effects and anti-depressive effects in clinics. The effect ofa sub-anesthesia dose of S-ketamine on postoperative pain and anxiety remains to be clarified. 

Methods: One hundred twenty patients receiving breast or thyroid surgery, stratified by surgerytype, were randomized to S-ketamine and control groups in a 1:1 ratio. S-ketamine (0.3 mg/kg) oran equal volume of normal saline was administrated after anesthesia induction. Visual analog scale(VAS) of pain and self-rating anxiety scale (SAS) were tested before surgery and on postoperativeday 1, 2, and 3. VAS and SAS score between the 2 groups were compared, and the risk factors forpostoperative moderate to severe pain were explored with logistic regression analysis. 

Results: Intraoperative S-ketamine decreased VAS and SAS scores on postoperative day 1, 2,and 3 (P < 0.05, 2-way ANOVA for repeated measurements followed by Bonferroni post-analysis).Subgroup analysis showed S-ketamine decreased VAS and SAS scores both in breast surgeryand thyroid surgery patients on postoperative day 1, 2, and 3. Logistic regression identifiedS-ketamine and regular exercise are protective factors, and anxiety before surgery is a risk factorfor postoperative moderate to severe pain (P < 0.05).

Conclusions: Intraoperative sub-anesthesia dose of S-ketamine reduces postoperative pain andanxiety intensity. Anxiety before surgery is a risk factor, and S-ketamine and regular exercise areprotective factors for postoperative pain.

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