Discussion
postoperative pain, postoperative cognitive dysfunction, neuroinflammation, nausea, anxiety, cognitive impairment, hyperalgesia, ileus, cancer, chronic pain, pain, vertigo, dizziness, urinary retention, dysgeusia, PONV, depression, trauma
ADVERSE REACTIONS, ADVERSE EVENTS, CANCER, DISEASE, CHRONIC PAIN, RESPIRATORY DEPRESSION, ILEUS
In order to explore the potential effects of general anesthesia combined with S-ketamine on postoperative quality of recovery (QoR-15) and cognitive function in patients undergoing MRM. In this study, patients with BC were allocated to either the S-ketamine or control intervention group. Our results revealed that general anesthesia with S-ketamine can improve the early QoR-15 score both at POD1 and POD2. When assessed with regard to MMSE score, we have observed that the score measured in the S-ketamine group had a higher MMSE score than in the control group on POD1, but not on POD2. Furthermore, we confirmed that general anesthesia with S-ketamine brings substantial favorable benefits to postoperative pain management, decreases the opioid and propofol consumption. We believe that the findings of this study are of clinical guiding significance to evaluate general anesthesia with S-ketamine for BC patients from the perspective of postoperative recovery.Recovery from anesthesia and surgery is a complicated process and maybe affected by various factors. Poor recovery may increase the likelihood of postoperative morbidity. Therefore, improving postoperative rehabilitation is of great significance to surgery patients. The QoR-15 is one of the most frequently used, well-known patient-reported scale [In this study, the QoR-15 scale was applied to measure and compare the quality of postoperative rehabilitation between the two groups. The present results showed that S-ketamine can significantly improve the quality of recovery at POD1 and POD2. Moreover, further analysis conducted from the five subcomponents of QoR-15 manifested an increase of QoR-15 scores in the S-ketamine group was mainly reflect in pain, physical comfort, and emotional state, which account for 110 points out of the total score-pain (20 points), physical comfort (50 points) and emotional state (40 points). In other words, S-ketamine can effectively control patients’ postoperative pain, relieve their negative emotions, and improve patients’ physical comfort, thereby facilitating postoperative rehabilitation. Wang et al. confirmed that S-ketamine could improve short-term depression and recovery from anesthesia [Based on previous studies and our results, we propose that the benefit of S-ketamine underlying this phenomenon is probably because of a combination of several factors: First, this maybe correlated with strong analgesic and antidepressant effects of S-ketamine, which could provide optimal postoperative pain management and alleviate the anxiety and depression caused by disease and surgical trauma. Second, it may be significantly related to the reduction of the occurrence of postoperative remedial analgesia and PONV, which may strengthen patient’s physical comfort and satisfaction.MMSE is the most commonly used cognitive functional assessment scale with many advantages, including easy evaluation and high acceptability by both doctors and patients [At present, the specific mechanism of S-ketamine to improve postoperative cognitive dysfunction remains to be further studied. Existing studies have shown that S-ketamine plays an important role in improving neuroinflammation. Wang et al. found [Especially, intensive perioperative analgesia management is essential to accelerate functional recovery, minimize discomfort, decrease the side effects and to increase overall patient satisfaction. Even the widely used, a great deal of researches confirmed that classic opioid medications are closely related to undesirable adverse reactions such as PONV, respiratory depression, cognitive impairment, ileus, urinary retention, and opioid-induced hyperalgesia [Our study also indicated that the safety profile of S-ketamine was promising. The most common adverse events of S-ketamine include dissociation, nausea, vertigo, dysgeusia, dizziness, and psychomimetic side effects [Nevertheless, it should be acknowledged that there are various limitations in this trial. First, this study only evaluated the QoR-15, MMSE, and pain score within 48 h after surgery. We did not carry out follow-ups regarding the long-term quality of life, cognitive function, and chronic pain after surgery. Therefore, understanding the effects of S-ketamine on long-term cognitive function, functional recovery, and chronic pain in cancer patients is of great research value. Second, the emotional recovery of patients was assessed only using the QoR-15 scale. Future studies with a more rigorous design are needed to assess the emotional recovery on a special depression assessment scale.