Chen YL, Feng TC, Zhang XM, Liu N, Yuan HM, Bian R, Yao J, Xing Z. Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study. World J Psychiatry 2026; 16(6): 119817 [DOI: 10.5498/wjp.v16.i6.119817]
Corresponding Author of This Article
Zhen Xing, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Zhangjiakou 075000, Hebei Province, China. 13011560235@163.com
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Psychiatry
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Chen YL, Feng TC, Zhang XM, Liu N, Yuan HM, Bian R, Yao J, Xing Z. Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study. World J Psychiatry 2026; 16(6): 119817 [DOI: 10.5498/wjp.v16.i6.119817]
World J Psychiatry. Jun 19, 2026; 16(6): 119817 Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.119817
Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study
Yan-Lin Chen, Teng-Chen Feng, Xiao-Min Zhang, Na Liu, Hui-Min Yuan, Rui Bian, Jie Yao, Zhen Xing
Yan-Lin Chen, Teng-Chen Feng, Xiao-Min Zhang, Na Liu, Hui-Min Yuan, Jie Yao, Zhen Xing, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Rui Bian, Counseling Center, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Co-corresponding authors: Jie Yao and Zhen Xing.
Author contributions: Chen YL, Feng TC, and Zhang XM contributed equally to this work; Chen YL and Feng TC designed the study, collected and analyzed the data, and drafted the manuscript; Zhang XM and Liu N participated in data collection and statistical analysis; Yuan HM and Bian R contributed to the interpretation of psychological assessments and critical revision of the manuscript; Yao J and Xing Z conceived the study, supervised the entire research process, and revised the manuscript for important intellectual content, have played important and indispensable roles in the manuscript preparation as the co-corresponding authors; all authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Supported by 2024 Hebei Provincial Medical Science Research Project, No. 20241120.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Hebei North University (No. K2024056).
Informed consent statement: The requirement for written informed consent was waived by the Ethics Committee of The First Affiliated Hospital of Hebei North University (No. K2024056). Given the retrospective design of the study and the use of existing, anonymized clinical data, the Ethics Committee determined that the research posed no more than minimal risk to participants. All procedures were conducted in accordance with the ethical standards of the institutional research committee and complied with the principles of the Declaration of Helsinki.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author (Zhen Xing, 13011560235@163.com) on reasonable request.
Corresponding author: Zhen Xing, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Zhangjiakou 075000, Hebei Province, China. 13011560235@163.com
Received: March 10, 2026 Revised: April 27, 2026 Accepted: May 20, 2026 Published online: June 19, 2026 Processing time: 78 Days and 23.9 Hours
Abstract
BACKGROUND
Post-traumatic stress disorder (PTSD) is a common psychological complication after radical lung cancer surgery and has a significant impact on postoperative recovery and quality of life. Esketamine, a new anesthetic agent, may be protective against postoperative PTSD through modulation of neurotransmitter systems and anti-inflammatory actions.
AIM
To explore the underlying mechanisms by which esketamine-assisted regional block prevents postoperative PTSD in patients undergoing radical lung cancer surgery.
METHODS
We conducted a retrospective review of the clinical data of 218 radical lung cancer surgery patients in our thoracic surgery department from January 2021 to December 2024. Patients were stratified by anesthetic protocol into a control group (regional block only, n = 106) and an esketamine group (esketamine assisted regional block, n = 112). At 3 months after the operation, postoperative PTSD occurrence was assessed by using the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Preoperative and 24-hour postoperative serum levels of cortisol and interleukin (IL)-6 were examined by enzyme-linked immunosorbent assay. Logistic regression analysis was performed to identify risk factors and receiver operating characteristic curves were used to assess predictive efficacy.
RESULTS
Among 218 enrolled patients (mean age: 58.4 ± 9.2 years; male proportion, 61.5%), there were 62 patients (28.4%) who developed PTSD at the postoperative period of 3 months. Esketamine injection was associated with considerably reduced PTSD rates relative to control (19.6% vs 37.7%, P < 0.001), a reduction of risk by 48% relative and an absolute risk difference of 18.1%. At 24 hours postoperatively, serum cortisol (326.4 ± 68.2 nmol/L vs 458.3 ± 92.6 nmol/L) and IL-6 levels (42.8 ± 12.6 pg/mL vs 68.4 ± 18.2 pg/mL) were significantly lower in the esketamine group compared with control subjects, respectively (P < 0.05). The multivariate analysis demonstrated that the esketamine use [odds ratio (OR) = 0.38; 95%CI: 0.19-0.74; P = 0.005], postoperative pain score (OR = 2.86; 95%CI: 1.52-5.38; P = 0.001) and postoperative IL-6 level (OR = 2.24; 95%CI: 1.18-4.26; P = 0.014) were independent factors contributing to PTSD occurrence. The combined prediction model had an area under the curve of 0.856 (95%CI: 0.802-0.910), and its sensitivity and specificity were respectively observed to be 78.7% and 84.6%.
CONCLUSION
Esketamine-assisted regional block could substantially reduce post-surgical PTSD prevalence after radical lung cancer surgery, probably via anti-stress-inflammation modulation. Post-operative pain management and inflammatory marker monitoring contribute to the better early diagnosis of potential high-risk PTSD patients. This study offers a new therapeutic strategy and theoretical foundation for the postoperative prevention of PTSD in lung cancer patients.
Core Tip: Post-traumatic stress disorder (PTSD) is a real complication impeding recovery and quality of life in patients undergoing radical lung cancer surgery. This study shows that esketamine-assisted regional block can significantly reduce the incidence of postoperative PTSD through inhibition of stress and inflammatory response. These findings suggest that refining perioperative anesthetic techniques, improving postoperative pain treatment and tracking inflammatory indicators are of clinical relevance in early PTSD prevention and will provide novel reference data for comprehensive interventions in lung cancer patients.
