Study on the Effect of Different Doses of Ketamine on Postoperative Opioid-Induced Hyperalgesia in Orthopedic Patients
OBJECTIVE To investigate the effect of preoperative injection of esketamine analgesia on remifentanil-induced postoperative opioid-induced hyperalgesia in patients undergoing orthopedic surgery.METHODS A total of 90 patients undergoing elective orthopaedic surgery were randomly divided into three groups according to different intravenous drugs 30 minutes before the end of the operation:low-concentration(0.2 mg·kg-1)D-ketamine group(group A),and high-concentration(0.4 mg·kg-1)D-ketamine group(group B)and normal saline(NS)(group C),30 cases in each group.The eye opening time,tracheal intubation time,intraoperative atropine and phenylephrine usage rates were compared among the three groups,the dosage of remifentanil and propofol.The NRS static and dynamic score and Ramsay sedation score of patients in each group at immediately after extubation(T0),15 minutes after extubation(T1),30 minutes after extubation(T2)and 2 hours after extubation(T3)were observed and recorded.And the occurrence of adverse reactions such as nausea and vomiting,agitation,drowsiness,dizziness and skin itching in each group within 24 hours after operation were recorded.RESULTS There was no significant difference in eye opening time,tracheal intubation time,use rate of atropine and phenylephrine among the three groups.The use of remifentanil and propofol in group B was significantly lower in groups C and A,the usage of remifentanil and propofol in group A was significantly lower than that in group C,and the static and dynamic scores of NRS pain in group B at four time points from T0 to T3 were significantly lower than those in group C.The static and dynamic scores of NRS pain in group B at T0-T1 were significantly lower than those in group A,the static and dynamic scores of NRS pain in group A were significantly lower than those in group C at time-point T0-T1,and the Ramsay score of group B at time T0 was significantly lower than that of group C and group A.The incidence of nausea and vomiting,restlessness,drowsiness,dizziness and skin pruritus within 24 hours after operation of the three groups had no significant difference.CONCLUSION Intravenous injection of esketamine 30 minutes before the termination of surgery in patients with orthopedic surgery can effectively improve postoperative analgesia and reduce the use of intraoperative anesthetics,effectively inhibit opioid-induced hyperalgesia after remifentanil anesthesia,and it's much safer.
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