Application Of Preventive Analgesia With Esketamine In Spinal Surgery

Objective To compare the effects of different doses of esketamine and dezocine on the preventive analgesia of esketamine（S（+）-ketamine）in spinal surgery.Methods From April 2022to October 2022,60 patients undergoing lumbar fusion surgery in Wuhan Fourth Hospital were selected and divided into three groups:dezocine control group（group C）,low-dose esketamine group（S1）,high-dose esketamine group（S2）.Routine monitoring was performed in the room.Lumbar fusion surgery was performed after general anesthesia through orotracheal intubation.The operation time was 2-4 hours.During flushing and suturing,group C,group S1,and group S2 were given dezocine 0.1 mg/kg,esketamine 0.25 mg/kg,and esketamine 0.5 mg/kg,respectively.After the operation,the recovery was observed and compared in three groups patients:recovery time,extubation time,spontaneous breathing recovery time,extubation agitation score;hemodynamic changes:systolic blood pressure,diastolic blood pressure and heart rate at 30min（t₁）,10min（t₂）before extubation and 10min（t₃）,30min（t₄）after extubation.Postoperative pain included BCS comfort score,VAS pain score,Ramsay sedation score and incidence of adverse reactions at 5min（T₁）,30min（T₂）,2h（T₃）,6h（T₄）,12h（T₅）and 24h（T₆）after extubation.Results There were significant differences in VAS scores among the three groups at T₂,T₃and T₄（P<0.05）.The VAS score of group C was higher than that of group S1and S2,but there was no significant difference in VAS score between group S1 and group S2 at the measured time points（T₁-T₆）.There was significant difference in BCS comfort score at T₄,and group S1 and S2 were higher than group C,but there was no significant difference between group S1 and S2.The agitation score of group C was higher than that of group S1 and S2（P<0.05）,but there was no significant difference between group S1 and S2.The Ramsay sedation score of the three groups at T₁was compared.The score of group S2 was higher than group C.The difference was statistically significant;the Ramsay score of group S1 was higher than group C,but the difference was not statistically significant.There was no significant statistically difference between group S1 and group S2.There was no significant statistically difference in Ramsay score between the three groups at T₂-T₆（P>0.05）.There was no significant difference in the recovery time,extubation time,spontaneous breathing recovery time,non-invasive systolic blood pressure,diastolic blood pressure,heart rate and incidence of adverse reactions at different time points among the three groups（P>0.05）.Conclusion Esketamine for preventive analgesia in patients undergoing spinal surgery can relieve early pain,but there is no significant correlation between analgesic effect and dose.When 0.5 mg/kg esketamine is given,the sedation score during recovery period is higher.We can draw a conclusion that 0.25 mg/kg esketamine is more recommended for preventive analgesia in patients undergoing spinal surgery.