Yang Qun, Luo Qian, Cheng Lei, Yang Ze-Xue, Rao Li-Hao, Cheng Feng, Zheng Li-Dong
Department of Graduate, Bengbu Medical University, Bengbu, China.
Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, China.
J Perianesth Nurs. 2025 May 27. doi: 10.1016/j.jopan.2025.01.012.
This study aims to investigate the efficacy of a combination of ropivacaine hydrochloride and esketamine in paravertebral block (PVB), in providing analgesia and promoting the postoperative recovery of patients undergoing elective thoracoscopic radical lung cancer surgery.
A randomized controlled trial was conducted involving 70 patients scheduled for elective thoracoscopic radical lung cancer surgery.
Participants were randomly assigned to either the esketamine group (K group) or the control group (C group). Patients in the K group were administered a combination of 0.1 mg/kg of esketamine and 0.5% ropivacaine for PVB, while patients in the C group received only 0.5% ropivacaine. The time interval between the patient's discharge from the postanesthesia care unit and the first press of the analgesic pump and the number of presses. Various parameters that were monitored included the patients' mean arterial pressure, heart rate, and oxygen saturation at different time points; levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein in venous blood preoperatively and 6 hours postoperatively; pain assessed using the numeric rating scale scores.
Compared with group C, patients in group K had significantly longer intervals before their first postoperative analgesic pump press and significantly fewer effective analgesic pump presses in the 48-hour postoperative period. Resting numeric rating scale scores were significantly lower in group K at 24 and 48 hours postoperatively (both P < .05). In terms of postoperative recovery, sedation score during extubation was lower in group K compared with group C (P < .05). Patients in group K had significantly improved quality of recovery on the third day postoperatively (both P < .05). The levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein in venous blood were significantly lower in group K than in group C 24 hours postoperatively, and the difference was statistically significant (P < .05).
PVB with ropivacaine hydrochloride combined with esketamine effectively prolonged the time to the first analgesic pump use, reduced the overall analgesic pump requirement, and facilitated rapid recovery in patients undergoing thoracoscopic radical lung cancer surgery.
本研究旨在探讨盐酸罗哌卡因与艾司氯胺酮联合用于胸椎旁神经阻滞（PVB），对接受择期胸腔镜根治性肺癌手术患者的镇痛效果及促进术后恢复的作用。
进行一项随机对照试验，纳入70例计划接受择期胸腔镜根治性肺癌手术的患者。
参与者被随机分配至艾司氯胺酮组（K组）或对照组（C组）。K组患者在胸椎旁神经阻滞时给予0.1mg/kg艾司氯胺酮与0.5%罗哌卡因的联合用药，而C组患者仅接受0.5%罗哌卡因。记录患者从麻醉后监护病房出院至首次按压镇痛泵的时间间隔以及按压次数。监测的各项参数包括不同时间点患者的平均动脉压、心率和血氧饱和度；术前及术后6小时静脉血中白细胞介素-6、肿瘤坏死因子-α和C反应蛋白的水平；采用数字评分量表评估疼痛程度。
与C组相比，K组患者术后首次按压镇痛泵的间隔时间显著延长，术后48小时内有效按压镇痛泵的次数显著减少。术后24小时和48小时，K组静息数字评分量表得分显著更低（均P<0.05）。在术后恢复方面，K组拔管时的镇静评分低于C组（P<0.05）。K组患者术后第三天的恢复质量显著改善（均P<0.05）。术后24小时，K组静脉血中白细胞介素-6、肿瘤坏死因子-α和C反应蛋白的水平显著低于C组，差异具有统计学意义（P<0.05）。
盐酸罗哌卡因联合艾司氯胺酮用于胸椎旁神经阻滞可有效延长首次使用镇痛泵的时间，减少镇痛泵的总体使用需求，并促进胸腔镜根治性肺癌手术患者的快速恢复。
