Effect of continuous intraoperative infusion of esketamine on postoperative hyperalgesia in patients undergoing pulmonary surgery
Objective To observe the effects of esketamine on postoperative hyperalgesia in patients undergoing pulmonary surgery.Methods Seventy patients scheduled for elective pulmonary surgery were selected,including 36 males and 34 females,aged 18-64 years,BMI 18.5-28.0 kg/m2,ASA physi-cal statusⅡorⅢ.Patients were randomly divided into two groups using a random number table:the esket-amine group(group E,n=34)and the control group(group C,n=36).Group E received an intrave-nous injection of esketamine at 0.25 mg/kg during anesthesia induction,followed by continuous infusion at 0.15 mg·kg-1·h-1 until 30 minutes before the end of surgery.Group C received an equivalent volume of normal saline.During surgery,both groups received propofol at 6 mg·kg-1·h-1 and remifentanil at 0.1 μg·kg-1·min-1 via micro-infusion pumps,followed by patient-controlled intravenous analgesia(PCIA)with sufentanil after surgery.Mechanical pain thresholds at the non-dominant forearm and around the surgical incision were measured 1 day before surgery and at 2,24,48,and 72 hours after surgery.The inci-dence of hyperalgesia was recorded at 2,24,48,and 72 hours post-surgery,along with VAS pain scores at 2,24,48,and 72 hours,and on 7 days after surgery.Total perioperative morphine milligram equivalent(MME)consumption and the number of successful and total PCIA attempts were also documented.Addi-tionally,rescue analgesia use was recorded within 0-24 hours,25-72 hours,and 73 hours to 7 days after surgery.Sleep parameters,including time to fall asleep,total sleep duration,and sleep quality,were as-sessed 1 day before and 7 days after surgery.Adverse reactions,such as hallucinations,nausea and vomi-ting,itching,dizziness,headache,and agitation,were monitored within 7 days after surgery.Results Compared with group C,group E showed a significant increase in the mechanical pain threshold at the non-dominant forearm and around the surgical incision at 2 and 24 hours postoperatively(P＜0.05)and a sig-nificant increase around the incision at 48 hours after surgery(P＜0.05).The incidence of hyperalgesia at the non-dominant forearm and the surgical incision was significantly lower in group E 2 and 24 hours postop-eratively(P＜0.05).VAS pain scores,both at rest and during activity,were significantly lower in group E 12,24,and 48 hours after surgery(P＜0.05).Group E also had significantly lower total MME consump-tion and fewer effective and total PCIA presses(P＜0.05).The frequency of rescue analgesia use was sig-nificantly reduced within 0-24 hours and 25-72 hours postoperatively(P＜0.05).Additionally,group E experienced a shorter time to fall asleep(P＜0.05),longer sleep duration(P＜0.05),but lower sleep quality scores(P＜0.05).There was no statistically significant difference between the two groups in the in-cidence of adverse reactions,such as hallucinations,nausea and vomiting,itching,dizziness,headache,and agitation,within 7 days postoperatively.Conclusion Intraoperative infusion of esketamine at a rate of 0.15 mg·kg-1·h-1 has been shown to effectively mitigate acute postoperative pain,reduce opioid depend-ence,and attenuate hyperalgesia,and exhibits a favorable safety profile.
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