• Dongxu Zhou, Fan Liu, Fei Jiang, Xihong Ye, Xingrui Gong, and Mazhong Zhang.
• Department of Neuroscience and Brain Disease, Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
• Pain Physician. 2023 May 1; 26 (3): 257264257-264.

BackgroundPostoperative pain and anxiety affect patients' recovery and increase the family burden. S-ketamine presents analgesic effects and anti-depressive effects in clinics. The effect of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety remains to be clarified.ObjectivesThis study aimed to evaluate the analgesic and anxiolytic effects of a sub-anesthesia dose of S-ketamine on postoperative pain and anxiety and explored the risk factors for postoperative pain in patients receiving breast or thyroid surgery under general anesthesia.Study DesignA randomized, double-blind, controlled trial.SettingA university hospital.MethodsOne hundred twenty patients receiving breast or thyroid surgery, stratified by surgery type, were randomized to S-ketamine and control groups in a 1:1 ratio. S-ketamine (0.3 mg/kg) or an equal volume of normal saline was administrated after anesthesia induction. Visual analog scale (VAS) of pain and self-rating anxiety scale (SAS) were tested before surgery and on postoperative day 1, 2, and 3. VAS and SAS score between the 2 groups were compared, and the risk factors for postoperative moderate to severe pain were explored with logistic regression analysis.ResultsIntraoperative S-ketamine decreased VAS and SAS scores on postoperative day 1, 2, and 3 (P < 0.05, 2-way ANOVA for repeated measurements followed by Bonferroni post-analysis). Subgroup analysis showed S-ketamine decreased VAS and SAS scores both in breast surgery and thyroid surgery patients on postoperative day 1, 2, and 3. Logistic regression identified S-ketamine and regular exercise are protective factors, and anxiety before surgery is a risk factor for postoperative moderate to severe pain (P < 0.05).LimitationsThe anxiety score in our study is not so high, which may under-evaluate the anxiolytic effect of S-ketamine. However, S-ketamine decreased the SAS scores postoperatively in our study.ConclusionsIntraoperative sub-anesthesia dose of S-ketamine reduces postoperative pain and anxiety intensity. Anxiety before surgery is a risk factor, and S-ketamine and regular exercise are protective factors for postoperative pain. The study was registered at www.chictr.org.cn with the number: ChiCTR2200060928.

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