Abstract
Low-dose ketamine has been proved to reduce opioid consumption, prevent depressant action and improve postoperative analgesia. Women undergoing mastectomy experience may not only have persistent postoperative pain syndromes but also emotional problems. However, the effect of intraoperative infusion of low-dose ketamine on postoperative quality of recovery among these patients has not yet been fully studied. In this prospective, randomised, single-centre trial, 100 patients planned for modified radical mastectomy were randomly assigned to one of two groups: control group (group C) or ketamine group (group K) at a ratio of 1:1. Group K received the bolus dose of 0.5mg/kg ketamine and followed by 0.25mg·kg-1 ·h-1 after the compliment of anaesthesia induction until the end of the surgery, whilst group C received an equivalent dose and regiment of normal saline was group K. The primary outcome was to assess the effects of low-dose ketamine on postoperative quality of recovery using the 40-Item Quality of Recovery (QoR-40) scale on a postoperative day 1 (POD1). The secondary outcome was to assess the numeric rating scale (NRS) at 4, 24 and 48h after the operation, identity-consequence fatigue scale (ICFS) scores at 3 and 7days after the operation, hospital anxiety and depression scale (HADS) scores at 2days and 3months, as well as chronic pain at 3months. In a post hoc analysis, the 5 subsections of the QoR-40 scores were also analysed. A total of 100 subjects were randomised. The primary outcome of QoR-40 scores on POD1 was available in 97 patients (49 in group C and 48 in group K). Global QoR-40 scores were not significantly different between group C and group K (169.8±10.7 vs. 172.7±7.5, 95% CI -1.35 (-5.50, 2.80), p=.519). In a post hoc analysis, pain scores were significantly higher in group K than in group C (29.8±3.8 vs. 31.7±2.1, 95% CI -1.81 (-3.00, -0.62), p=.003). The secondary outcomes, including NRS, ICFS scores, HADS scores and chronic pain had no difference between groups (p value for each >.15). Intraoperative low-dose ketamine infusion did not improve the overall quality of recovery on POD 1 in patients undergoing breast cancer surgery.
Highlights
Intraoperative low dose ketamine has been widely studied for postoperative multimodal analgesia
Female patients aged 20–65 years old and American Society of Anesthesiologists physical status I or II scheduled to undergo breast cancer surgery under general anesthesia were enrolled between September 2018 and February 2019
A total of 100 patients were randomly assigned to the different groups, as seven patients cancelled the operation and three patients withdrew consent; 49 patients were allocated to group C, and 48 patients were allocated to group K
Summary
Intraoperative low dose ketamine has been widely studied for postoperative multimodal analgesia. The effect of low dose ketamine on postoperative quality of recovery in female patients undergoing breast cancer surgery has not been studied. The second aim of this study was to evaluate the effects of intraoperative infusion of low-dose ketamine on chronic postoperative surgical pain (CPSP). Adequate control of acute pain after modified radial mastectomy is crucial for recovery, but chronic postsurgical pain (CPSP) after mastectomy is often underestimated and poorly recognized.[2] the incidence of chronic and neuropathic pain after modified radical mastectomy is relatively high across surgery types It often has a neuropathic component and continues to plague patients.[3] identifying effective treatments to promote patient recovery and reduce chronic pain is critical for breast cancer patients to reintegrate into society
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