Objective: To investigate the effects of multi-day low dose ketamine infusion for postmastectomy pain syndrome (PMPS) after breast cancer surgery. Methods: This study was a prospective randomized controlled trial. From June 2015 to May 2016 in Affiliated Yiwu Hospital of Wenzhou Medical University, 66 patients with breast cancer surgery were randomly divided into control group (group C) and ketamine group (group K). Patients in group K were infused with 0.5 mg/kg of ketamine mixed in 250 ml of 0.9% normal saline in 1 h daily for 7 days. Patients in group C were infused the same dose of 0.9% normal saline. Anesthesia induction in both groups were given intravenous midazolam, sufentanil, propofol, vecuronium and intermittent positive pressure ventilation after tracheal intubation, anesthesia was maintained with propofol and remifentanil. After awakening, all patients were monitored in postanesthesia care unit (PACU) and given patient-controlled intravenous analgesia(PCIA). Pain scores were assessed using visual analogue scales (VAS) during PACU, 4 h, 24 h and 2-5 d after surgery, simultaneously analgesic requirement were recorded. Patients were evaluated Hospital Anxiety and Depression Scale (HADS) 5 d after surgery . The patients were followed up for 6 months. At 3 m, 6 m after surgery, the incidence of PMPS, the level of pain, pain site and HADS scale were assessed. Results: The VAS score uring PACU, 4 h, 24 h and 2-5 d after surgery in group K( (2.5±0.8), (2.4±0.5), (2.4±0.5), (2.0±0.4), (1.5±0.5), (1.0±0.4), 1(1), respectively) was lower than those in group C ((2.9±1.0), (2.9±0.6), (2.6±0.5), (2.3±0.5), (1.8±0.6), (1.5±0.5), 1(0), respectively). There was statistically difference between the two groups (all P<0.05). The consumption of analgesics required at each time postoperation in group K were also lower than that of group C(all P<0.05). Followed up for 6 months, 2 lost in group C, 1 lost in group K. The incidence of PMPS in group K at 3 months and 6 months after surgery was significantly lower(25% and 22%) than that in group C(52% and 45%)(χ(2)=4.729, 3.842, all P<0.05). There were no significant difference in pain level and site between two groups of PMPS patients (all P>0.05). There were no significant difference of HADS scale preoperative and 5 d after surgery between two groups (all P>0.05); and HADS scale in group K at 3 m and 6 m after surgery was significantly lower than that in group C(all P<0.05). Conclusion: Perioperative continuous multi-day low dose ketamine infusion can effectively reduce the incidence of PMPS after breast cancer surgery.
目的： 探讨围手术期多日低剂量氯胺酮输注对乳腺癌手术患者乳房切除术后疼痛综合征(PMPS)的影响。 方法： 选取2015年6月至2016年5月温州医科大学附属义乌医院66例乳腺癌手术患者，采用随机数字表法分为对照组(C组，n＝33)和氯胺酮组(K组，n＝33)。K组患者术前1 d开始每天接受氯胺酮0.5 mg/kg稀释至250 ml 0.9%生理盐水输注1.0 h，连续7 d。C组患者给予同等剂量0.9%生理盐水。两组患者术中均采用相同的全凭静脉麻醉及气管插管管理(咪唑安定、舒芬太尼、丙泊酚和维库溴铵诱导，丙泊酚、瑞芬太尼维持麻醉)。麻醉苏醒后转至麻醉后恢复室(PACU)，观察并给予患者自控静脉镇痛泵(PCIA)。记录入PACU时、术后4 h、术后24 h及术后2～5 d患者疼痛视觉模拟评分(VAS)、镇痛药需求量及术后5 d医院焦虑抑郁评分(HADS)。随访患者6个月并评估患者术后3、6个月时PMPS发生率、疼痛程度、疼痛部位及HADS。 结果： K组患者入PACU时、术后4 h、术后24 h及2～5 d疼痛VAS评分分别为(2.5±0.8)、(2.4±0.5)、(2.4±0.5)、(2.0±0.4)、(1.5±0.5)、(1.0±0.4)、1(1)分，均低于C组的(2.9±1.0)、(2.9±0.6)、(2.6±0.5)、(2.3±0.5)、(1.8±0.6)、(1.5±0.5)、1(0)分，差异均有统计学意义(均P<0.05)；术后各时段所需镇痛药的消耗量亦均低于C组，差异均有统计学意义(均P<0.05)。随访6个月，C组失访2例，K组失访1例，K组术后3、6个月时PMPS的发生率为25%、22%，均显著低于C组的52%、45%，差异均有统计学意义(χ(2)＝4.729、3.842，均P<0.05)；两组PMPS患者中，术后3、6个月时VAS>3分的比例、疼痛部位方面比较差异均无统计学意义(均P>0.05)；两组患者术前、术后5 d HADS评分差异均无统计学意义(均P>0.05)，K组患者术后3、6个月时HADS评分显著低于C组，差异均有统计学意义(均P<0.05)。 结论： 围手术期连续多日低剂量氯胺酮输注能有效降低乳腺癌术后PMPS的发生率。.
Keywords: Breast neoplasms; Dose-response relationship, drug; Ketamine; Pain, postoperative; Surgical procedures, operative.