Jing Zhaojun, Han Yu, Li Yi, Zeng Rui, Wu Jin, Wang Yiting, Jiang Peng
Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Heliyon. 2024 Mar 5;10(5):e27593. doi: 10.1016/j.heliyon.2024.e27593. eCollection 2024 Mar 15.
Postoperative pain is prevalent and severe complication in elderly surgical patients. Multiple studies propose that a small dose of esketamine administered intraoperatively can alleviate postoperative pain and curtail opioid usage. We aimed to evaluate the impact of esketamine on postoperative acute pain among elderly patients with gastrointestinal tumors.
This is a prospective, parallel-group, randomized controlled trial. Ninety patients aged 60 and above, undergoing resection of gastrointestinal tumors, were randomly assigned to two groups: esketamine group (Group S, a single dose of 0.25 mg/kg and 0.1 mg/kg/h infusion) and control group (Group C, saline). Visual Analogue Scale (VAS) pain scores were the primary outcome. Remifentanil consumption, instances of rescue analgesia, delirium, sleep quality, postoperative recovery quality, serum levels of inflammatory cytokines, and adverse events within 72 h post-surgery were secondary outcomes, respectively.
Data of 87 of 99 eligible patients were analyzed. VAS scores at rest in Group S were lower than those in Group C at 6 h [1.2 (0.6, 1.6) vs 1.6 (1.0, 2.0), P = 0.003], 12 h [1.4 (1.0, 2.0) vs 2.0 (1.5, 2.0), P < 0.001], and 24 h [1.8 (1.3, 2.0) vs 2.2 (1.6, 2.6), P < 0.001] postoperatively. At 6 h post-surgery, VAS score during coughing was lower in Group S than Group C [2.0 (2.0, 2.3) vs 2.0 (2.0, 3.0), P = 0.009]. The instances of rescue analgesia were fewer in group S compared to group C (P = 0.007). Furthermore, the esketamine group showed improved sleep quality and QoR-15 score (P < 0.05) postoperatively.
Intravenous administration of esketamine as an adjunct to general anesthesia can decrease the intensity of pain for 24 h without additional adverse effects after laparoscopic gastrointestinal tumor surgery.
术后疼痛在老年外科患者中普遍存在且是严重并发症。多项研究表明，术中给予小剂量艾司氯胺酮可减轻术后疼痛并减少阿片类药物的使用。我们旨在评估艾司氯胺酮对老年胃肠道肿瘤患者术后急性疼痛的影响。
这是一项前瞻性、平行组、随机对照试验。90例年龄在60岁及以上、接受胃肠道肿瘤切除术的患者被随机分为两组：艾司氯胺酮组（S组，单次剂量0.25mg/kg，静脉输注0.1mg/kg/h）和对照组（C组，输注生理盐水）。视觉模拟评分法（VAS）疼痛评分是主要观察指标。瑞芬太尼用量、补救镇痛次数、谵妄、睡眠质量、术后恢复质量、血清炎症细胞因子水平以及术后72小时内的不良事件分别为次要观察指标。
分析了99例符合条件患者中的87例数据。术后6小时，S组静息时VAS评分低于C组[1.2（0.6，1.6）对1.6（1.0，2.0），P = 0.003]，12小时[1.4（1.0，2.0）对2.0（1.5，2.0），P < 0.001]，24小时[1.8（1.3，2.0）对2.2（1.6，2.6），P < 0.001]。术后6小时，S组咳嗽时VAS评分低于C组[2.0（2.0，2.3）对2.0（2.0，3.0），P = 0.009]。S组补救镇痛次数少于C组（P = 0.007）。此外，艾司氯胺酮组术后睡眠质量和QoR - 15评分改善（P < 0.05）。
腹腔镜胃肠道肿瘤手术后，静脉注射艾司氯胺酮作为全身麻醉的辅助用药可在24小时内减轻疼痛强度且无额外不良反应。
