Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study

Table 1 Baseline characteristics of patients, n (%)/mean ± SD

Characteristics	Control group (n = 106)	Esketamine group (n = 112)
Age (years)	58.8 ± 9.6	58.1 ± 8.9
Male	67 (63.2)	67 (59.8)
BMI (kg/m2)	23.4 ± 3.2	23.8 ± 3.4
ASA classification II/III	82/24	88/24
Tumor stage I/II/III	46/38/22	52/40/20
Surgical approach (VATS/open)	74/32	80/32
Preoperative cortisol (nmol/L)	284.6 ± 52.4	278.2 ± 48.6
Preoperative IL-6 (pg/mL)	12.4 ± 3.8	11.8 ± 3.6

No significant differences were observed between groups (all P > 0.05). BMI: Body mass index; ASA: American Society of Anesthesiologists; VATS: Video-assisted thoracoscopic surgery; IL-6: Interleukin-6.

Table 2 Surgical parameters and postoperative recovery indicators, mean ± SD

Parameters	Control group (n = 106)	Esketamine group (n = 112)	P value2
Operative duration (minute)	186.4 ± 42.8	182.6 ± 38.4	0.476
Intraoperative blood loss (mL)	168.4 ± 86.2	162.8 ± 82.6	0.618
Extubation time (minute)	18.6 ± 6.4	14.2 ± 5.8	< 0.001
Intensive care unit stay duration (hour)	28.4 ± 12.6	22.8 ± 10.2	0.001
Hospital length of stay (day)	8.6 ± 2.4	7.8 ± 2.2	0.012
Chest tube drainage duration (day)	4.8 ± 1.6	4.4 ± 1.4	0.065
Total opioid consumption (mg)1	86.4 ± 24.2	64.8 ± 18.6	< 0.001

¹Total opioid consumption expressed as oral morphine equivalents in milligrams, calculated using standard equianalgesic conversion ratios for all administered opioids including intravenous fentanyl, sufentanil, and oral oxycodone.

²P values were calculated using independent samples t-test.

Table 3 Post-traumatic stress disorder incidence and post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders-fifth edition scores at 3 months postoperatively, n (%)/mean ± SD

Parameters	Control group (n = 106)	Esketamine group (n = 112)	P value
PTSD incidence	40 (37.7)	22 (19.6)	0.002
Total PCL-5 score	31.2 ± 10.4	24.3 ± 8.6	< 0.001
Intrusive symptoms	8.4 ± 3.2	6.2 ± 2.6	< 0.001
Avoidance behaviors	6.8 ± 2.4	5.2 ± 2.2	< 0.001
Negative cognition and mood	9.6 ± 3.8	7.4 ± 2.8	< 0.001
Heightened arousal	6.4 ± 2.6	5.5 ± 2.0	0.006

P values were calculated using χ² test for categorical variables and independent samples t-test for continuous variables. PTSD: Post-traumatic stress disorder; PCL-5: Post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth edition.

Table 4 Comparison of serum cortisol, interleukin-6 levels, and pain scores, mean ± SD

Parameters	Control group (n = 106)	Esketamine group (n = 112)	P value
Serum cortisol (nmol/L)
24 hours postoperative	458.3 ± 92.6	326.4 ± 68.2	< 0.001
Serum IL-6 (pg/mL)
24 hours postoperative	68.4 ± 18.2	42.8 ± 12.6	< 0.001
VAS pain scores
6 hours postoperative	5.2 ± 1.4	3.8 ± 1.2	< 0.001
24 hours postoperative	4.6 ± 1.2	3.2 ± 1.0	< 0.001
48 hours postoperative	3.8 ± 1.0	2.6 ± 0.8	< 0.001
72 hours postoperative	3.2 ± 0.8	2.2 ± 0.6	< 0.001

P values were calculated using independent samples t-test. IL: Interleukin; VAS: Visual Analog Scale.

Table 5 Univariate analysis of risk factors for post-traumatic stress disorder, n (%)

Variable	PTSD (n = 62)	Non-PTSD (n = 156)	P value
Age ≥ 60 years,	28 (45.2)	62 (39.7)	0.436
Female gender	28 (45.2)	56 (35.9)	0.192
Esketamine use	22 (35.5)	90 (57.7)	0.002
ASA classification III	18 (29.0)	30 (19.2)	0.106
Operative duration ≥ 180 minutes	38 (61.3)	68 (43.6)	0.015
24 hours pain score ≥ 4	44 (71.0)	68 (43.6)	< 0.001
24 hours cortisol ≥ 400 (nmol/L)	34 (54.8)	52 (33.3)	0.002
24 hours IL-6 ≥ 55 (pg/mL)	42 (67.7)	62 (39.7)	< 0.001
Open thoracotomy	24 (38.7)	40 (25.6)	0.050

P values were calculated using χ² test. PTSD: Post-traumatic stress disorder; ASA: American Society of Anesthesiologists; IL: Interleukin.

Table 6 Multivariate logistic regression analysis of risk factors for post-traumatic stress disorder

Variable	OR	95%CI	P value
Esketamine use	0.38	0.19-0.74	0.005
Postoperative pain score ≥ 4	2.86	1.52-5.38	0.001
Postoperative IL-6 ≥ 55 pg/mL	2.24	1.18-4.26	0.014
Operative duration ≥ 180 minutes	1.98	1.06-3.70	0.033

OR: Odds ratio; IL: Interleukin.