Effect Of Sub-anaesthetic Doses Esketamine On Pain And Emotion In Patients Undergoing Laparoscopic Bariatric Surgery

Objective The purpose of this study was to investigate the effect and influence of different sub-anaesthetic doses of Esketamine on the pain and emotion in patients undergoing laparoscopic bariatric surgery,define the most appropriate dose and access the safety of sub-anaesthetic doses of Esketamine in those patients,so as to provide a basis for clinical work.MethodsA total of 80 patients were randomly divided to one of four groups(Group C、Group S1、Group S2、Group S3)with n=20 in each group.Group S1,S2,S3 received intravenous loading doses of Esketamine(0.15,0.25,0.35 mg/kg),followed by intravenous maintenance doses of 0.15,0.25,0.35 mg/kg/h.Postoperative pain scores and analgesic requirements were recorded at 6,12,24,48 h after the operation.Patient health questionnaire-9(PHQ-9)and generalized anxiety disorder 7-item scale(GAD-7)were used to assess the patients’ emotion on 1 day before surgery and day 2postoperatively.Consumption of anesthetics,perioperative hemodynamic variables,quality of recovery,complications were recorded at specific intervals.ResultA total of 80 patients were enrolled.The doses of 0.15,0.25,0.35 mg/kg/h Esketamine reduced the resting pain scores at 6,12,24 h after surgery(Bonferroni adjusted P<0.05).During movement,except for Group S2 at 48 h after the operation,group S had lower numeric rating scale(NRS)scores at 6,12,48 h after surgery than group C(Bonferroni adjusted P<0.05).There were no significant in pain scores between the Group S1,S2,S3 at rest or during movement(P>0.05).However,the analgesic requirements were similar among four groups within 48 hours postoperatively(P>0.05).Intraoperative continuous infusion of 0.15,0.25,and 0.35mg/kg/h Esketamine can not improve the mood in the early postoperative period(P>0.05).The 0.35 mg/kg/h dose of Esketamine can significantly reduce the consumption of propofol and remifentanil compare to group C and group S1(P<0.05).Patients in Group S2 received a lower cumulative consumption of remifentanil compare to Group C(P<0.05).Moreover,there was a reduction in the area under curve(AUC)of SBP in Group S2 and S3,compare to Group C(P<0.05)and the decrease was obvious in the Group S3,compare to Group S1(P<0.05).Finally,quality of recovery(P>0.05),adverse reactions and complications(P>0.05)did not differ among the four groups.ConclusionIntraoperative continuous infusion of Esketamine(0.15～0.35 mg/kg/h)can reduce postoperative pain without affecting the quality of recovery during the recovery period,and no significant adverse effects or complications were observed.However,it failed to improve the patients’ emotion during early postoperative period.The doses of 0.25、0.35 mg/kg/h Esketamine can decreased remifentanil use and contribute to the stability of intraoperative hemodynamics.Among them,0.35 mg/kg/h dose of Esketamine consumed less propofol during the operation and was probably better in maintaining hemodynamic stability.