The Analgesic Effectiveness Of Sub-Anesthetic Dose Esketamine After Total Hip Or Knee Arthroplasty

Backgroud:Whether intraoperative intravenous sub-anaesthetic doses of esketamine have great postoperative analgesia remains to be confirmed,and the sub-anaesthetic doses of esketamine are still not clearly defined,and the clinical effects of different sub-anaesthetic doses have not been compared.Methods:A total of 120 patients who were scheduled to undergo total hip or knee arthroplasty were randomly divided into four groups: A group(0.2mg/kg esketamine bolus),B group(0.3 mg/kg esketamine bolus),C group(0.4 mg/kg esketamine bolus)and D group(10ml saline bolus).Morphine consumption over multiple periods of 48 hours after surgery,short-and long-term postoperative VAS scores,adverse drug reactions and satisfaction rating were assessed.Results:Within 12 hours after surgery,the consumption of morphine in group C(40.3±4.9)was significantly lower than that in other groups(P=0.008),and there was no statistical difference among other groups(A:44.1±4.3,B:43.5±4.5,D:44.0±3.9),at 12-24 hours postoperatively,groups B(25.4 ± 2.9)and C(25.1 ± 3.7)had lower morphine consumption compared with group D(28.5 ± 4.3)with a significant difference(P=0.003),and there was no significant difference between the groups at 24-36 hours and 36-48 hours after surgery in morphine consumption;The incidence of dizziness in group C was significantly higher than that in groups A and D,and significantly lower in group D than Group B and Group C(P=0.005),there was no significant difference in the other adverse reactions among the groups;VAS scores were not significant difference among the groups at 1 h after surgery.VAS score in C group(4.3±0.7)was lowest at 2 hours after surgery,and there was a significant statistical difference compared with A group(P=0.01).Statistically significant differences among 4 groups at3 and 24 hours after surgery(P ≤ 0.001),comparisons between groups showed that lowest in C group(4.8±0.6,5.4±0.6)and significant differences.There was no significant difference in the VAS scores between the resting state and the exercise state at 1and 3 months after the operation;there was a statistical difference between the 4 groups at the time of discharge(P=0.034),and the comparison between the groups showed that the satisfaction of group C was the highest(9.5± 0.3).,and was significantly different from the other three groups;CAM score at various time points after surgery did not achieve statistical significance.Conclusion:Intraoperative use of 0.4 mg/kg esketamine within 24 hours after surgery resulted in lower VAS scores and morphine consumption,and higher postoperative satisfaction,but increased the incidence of postoperative dizziness.