Effects of a single epidural injection of low-dose esketamine on perioperative sedation and analgesia during cesarean section

Abstract

Objective To evaluate the analgesic and sedative effect of single epidural application of esketamine in cesarean section during perioperative period, and analyze the clinical application value of esketamine in cesarean section epidural analgesia and sedation. Methods From October 2021 to March 2022, 100 patients undergoing lower segment cesarean section under combined spinal epidural anesthesia in Rugao Hospital Affiliated to Nantong University were selected and randomly divided into morphine group (n=50) and esketamine group (n=50). After delivery of newborns (Apgar score ≥ 8) and removal of the umbilical placenta for 5 min, individuals in esketamine group were administered 20 mg ketamine, 5 mg dexamethasone plus 9 mg ropivacaine via an epidural catheter diluted with 0.9% sodium chloride to 6 mL; while individuals in morphine group were administered 2 mg morphine, 5 mg dexamethasone plus 9 mg ropivacaine via an epidural catheter, diluted with same volume (6 mL) of sodium chloride. The VAS score and Ramsay score at different time points after epidural administration, postoperative supplemental analgesic use and adverse reactions of the two groups were recorded. Results There was no significant difference between the two groups in VAS scores at 5 min after epidural administration, at the end of operation, 24 h after operation, and 48 h after operation, as well as the time of first use of supplementary analgesic drugs after operation and the proportion of the number of people (P＞0.05). At 5 min after epidural administration, Ramsay scores in esketamine group were significantly higher than those in morphine group (P＜0.05), and that there was no statistically difference in Ramsay scores between the two groups after surgery (P＞0.05). The incidence of dysuria (22.00% vs 4.00%, χ2=7.162, P＜0.05) and pruritus (18.00% vs 0, χ2=7.814, P＜0.05) in morphine group were higher than those in esketamine group. Conclusion Esketamine and morphine both exert effective analgesic effects during the perioperative period of cesarean section, and more importantly, ketamine is superior to morphine in sedative effect during cesarean section and reducing postoperative adverse reactions.

Keywords

• esketamine
• morphine
• cesarean section
• analgesia
• sedation
• epidural anesthesia