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Randomized Controlled Trial
. 2024 Apr 24;24(1):315.
doi: 10.1186/s12888-024-05753-9.

Effects of a single subanesthetic dose of esketamine on postoperative subthreshold depressive symptoms in patients undergoing unilateral modified radical mastectomy: a randomised, controlled, double-blind trial

Huanwei Wang #  1 , Rigen Te #  1 , Jianxing Zhang #  1 , Yanbing Su  1 , Hongxia Zhou  1 , Na Guo  2 , Dongmei Chi  3 , Wan Huang  4
Affiliations
Randomized Controlled Trial

Effects of a single subanesthetic dose of esketamine on postoperative subthreshold depressive symptoms in patients undergoing unilateral modified radical mastectomy: a randomised, controlled, double-blind trial

Huanwei Wang et al. BMC Psychiatry. .

Abstract

Background: Breast cancer is the most common malignant tumor in females worldwide. During disease development, breast cancer patients suffer anxious and depressed, which may lead to worse quality of life or even higher mortality. Esketamine has been regarded as an antidepressant in breast cancer patients with mild or moderate depression. Here, we wonder whether the administration of esketamine could reduce the postoperative depressive symptom score of breast cancer patients who have no preoperative depression.

Methods: A total of 64 patients treated with unilateral modified radical mastectomy were randomly divided into an experimental group (esketamine group, Group E) and a control group (Group C), with 32 cases in each one. After anesthesia induction, Group C received 0.2 ml/kg of normal saline intravenously and Group E was administered 0.2 mg/kg intravenous esketamine. The primary outcome was the Patient Health Questionnaire-9 (PHQ-9) scores. The secondary outcomes included the Visual Analogue Scale (VAS) scores for pain, inflammatory markers, perioperative-related indicators, and the incidence of postoperative delirium, nausea and vomiting.

Results: The PHQ-9 score on postoperative day (POD) 1 in Group E declined from the preoperative level, while the score in Group C was higher than before, and the former was far lower than the latter (P = 0.047). There is no statistically significant difference in PHQ-9 scores between Group E and Group C on POD 3, 7, and 30. Moreover, the postoperative leukocyte level of Group E was higher than that of Group C, and the difference was statistically significant (P = 0.030).

Conclusions: A single subanesthetic dose of esketamine can result in lower postoperative score on subthreshold depressive symptoms compared to the Group C on POD 1, without increasing the occurrence of postoperative adverse reactions.

Trial registration: Registration number: Chinese Clinical Trial Registry ChiCTR2200057028. Date of registration: 26/02/2022.

Keywords: Breast Cancer; Esketamine; Postoperative Subthreshold Depressive Symptoms.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of patient participanting in the study. Seven patients were excluded due to refusal to participate, one was excluded because of esketamine contraindications. Group C, control group. Group E, esketamine group
Fig. 2
Fig. 2
Perioperative related indicators of two groups. A The anesthesia time in two groups; (B) the dosage of remifentanil in two groups; (C) the extubation time in two groups. The box plot demonstrates the maximum, minimum, median, and quartile of various perioperative related indicators. C, control group. E, esketamine group
Fig. 3
Fig. 3
Changes in preoperative and postoperative inflammatory markers of two groups. (A) The CRP in two groups; (B) the WBC in two groups. The graph displays the mean and standard deviation of inflammatory markers collected preoperatively and on POD 1 in Group E and C, the Independent Samples T-test was used for statistical analysis. Group C, control group. Group E, esketamine group. CRP, C-reactive protein. POD, postoperative day. WBC, leukocyte. Compared with the control group at the same time point, *P < 0.05
Fig. 4
Fig. 4
Changes in preoperative and postoperative PHQ-9 scores between the two groups. The graph shows the mean and standard error of the perioperative PHQ-9 scores of the two groups, and scores of Group E and C at the same time point was compared with the Mann–Whitney U test. Group C, control group. Group E, esketamine group. PHQ-9, Patient Health Questionnaire-9. POD, postoperative day. Compared with the control group at the same time point, *P < 0.05
Fig. 5
Fig. 5
Changes in preoperative and postoperative VAS scores for pain of two groups. The graph shows the mean and standard error of the perioperative VAS scores of Group E and C. Group C, control group. Group E, esketamine group. VAS, visual analogue scale. POD, postoperative day
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