艾司氯胺酮在乳腺癌手术中的联合应用

Combined Application of Esketamine in Breast Cancer Surgery

摘要: 乳腺癌术后镇痛传统上以阿片类药物为主，然而其成瘾性强、恶心呕吐、呼吸抑制等不良反应日益受到关注。在无阿片麻醉与加速康复外科理念的推动下，艾司氯胺酮凭借其确切的镇痛和独特的抗抑郁作用逐渐进入临床视野。但近年研究表明，单纯应用艾司氯胺酮在减轻术后疼痛方面未显示出显著优势，提示联合用药方案可能成为更有效的镇痛策略。本文系统综述了艾司氯胺酮联合其他药物及区域神经阻滞在乳腺癌手术中的应用现状。在药物联合方面，重点探讨了艾司氯胺酮与右美托咪定、丙泊酚、利多卡因等的协同镇痛效果及其对不良反应的改善作用；在区域阻滞联合方面，分析了艾司氯胺酮与胸椎旁神经阻滞、竖脊肌平面阻滞、前锯肌平面阻滞及胸肌间神经阻滞等联合应用对术后疼痛和恢复质量的影响；同时关注了不同剂量艾司氯胺酮的临床效果差异。综述表明，艾司氯胺酮联合其他药物或区域神经阻滞可有效减少阿片类药物用量，降低恶心呕吐等不良反应发生率，同时提供满意的镇痛与抗抑郁效果，有望为乳腺癌手术患者提供更为优化的围术期镇痛方案。

Abstract: Postoperative pain management in breast cancer patients has traditionally relied primarily on opioid analgesics; however, their high potential for addiction, along with adverse effects such as nausea, vomiting, and respiratory depression, has increasingly come under scrutiny. Driven by opioid-sparing anesthesia and the principles of enhanced recovery after surgery, esketamine has gradually come into clinical focus, owing to its reliable analgesic effects and unique antidepressant properties. However, recent studies have shown that the use of esketamine alone does not confer a significant advantage in postoperative pain relief, suggesting that combination pharmacotherapy may represent a more effective analgesic strategy. This article provides a systematic review of the current status of esketamine, in combination with other medications and regional nerve blocks, in the context of breast cancer surgery. In the context of drug combinations, this study focused on the synergistic analgesic effects of esketamine in combination with dexmedetomidine, propofol, lidocaine, and other agents, as well as their ability to mitigate adverse reactions. In the context of regional anesthesia combinations, the effects of combining esketamine with thoracic paravertebral block, erector spinae plane block, serratus anterior plane block, and interpectoral nerve block on postoperative pain and recovery quality were analyzed. At the same time, attention was given to the differences in clinical efficacy among various doses of esketamine. This review indicates that the combination of esketamine with other pharmacological agents or regional nerve blocks can effectively reduce opioid consumption, decrease the incidence of adverse events such as nausea and vomiting, and provide satisfactory analgesia and antidepressant effects, thereby offering a more optimized perioperative pain management strategy for patients undergoing breast cancer surgery.