Effect of different administration methods of esketamine on postoperative pain after thoracoscopic lung surgery

Abstract

Objective To investigate the effect of itravenous injection or infuson of esketamine on postoperative pain in patients undergoing thoracoscopic lung surgery. Methods A total of 90 patients who underwent elective thoracoscopic lung surgery in Qingdao Municipal Hospital from January to June 2023 were selected and randomly divided into three groups: esketamine group 1 (EK1 group, 0.25 mg/kg of esketamine was injected intravenously after endotracheal intubation), esketamine group 2 (EK2 group, intravenous infusion of esketamine at a rate of 0.125mg·kg-1·h-1 for 2 hours after endotracheal intubation), and control group (C group, no administration of esketamine). All three groups were treated with intravenous rapid induction, double lumen tracheal intubation, and ultrasound guided surgical incision intercostal nerve block. When the postoperative pain numerical rating scale (NRS) score≥4 points, dezocine was given intravenously for rescue analgesia, with a single dose of 5 mg. The NRS score, hemodynamic indexes and blood gas indexes at different time points after operation were recorded. The rescue analgesia and adverse reactions of the three groups were compared. Results There was significant difference in NRS scores among the three groups (P＜0.05), and NRS scores of esketamine group (EK1 group and EK2 group) at each time point were lower than those of C group (P＜0.05). The number of cases of rescue analgesia within 48 h after operation in EK1 group, EK2 group and C group were 2, 3 and 13 cases respectively. The rescue analgesic rate and dezocine dosage of esketamine group (EK1 group and EK2 group) were lower than those of C group (P＜0.05), and the time of first pressing analgesic pump was later than that of C group (P＜0.05). There was no significant difference in the incidence of postoperative adverse reactions among the three groups (P＞0.05). Conclusion Intraoperative use of subanesthetic dose of esketamine, single intravenous injection, and continuous intravenous infusion can achieve the goal of reducing postoperative acute pain in patients undergoing thoracoscopic lung surgery, without increasing postoperative adverse reactions. Pre-operative single intravenous injection is more convenient to operate than continuous intravenous infusion, and there is no concern of delayed recovery. It is more recommended for pain relief in thoracoscopic lung surgery.

Keywords

• esketamine， thoracoscopy， postoperative pain， blood pressure， dezocine， intravenous injection， intravenous infusion， subanaesthetic dose