Effect of esketamine on analgesic effect and quality of awakening in patients / 中华内分泌外科杂志

ABSTRACT

Objective:To investigate the analgesic effect and quality of awakening of esketamine in patients undergoing laparoscopic total hysterectomy.Methods:100 patients who underwent laparoscopic total hysterectomy in our hospital from Mar. 2021 to Mar. 2023 were selected and randomly divided into the observation group ( n=50) and the control group ( n=50) . The observation group were injected esketamine during the operation, and the control group were injected an equal amount of saline. Anesthesia induction, maintenance and postoperative analgesic medication were kept the same in both groups. The hemodynamic indexes of heart rate (HR) and mean arterial pressure (MAP) of the two groups were monitored at the moment of entering the room (T0) , the moment of saline/exketamine infusion (T1) , the moment of surgical skin incision (T2) , the moment of skin suture (T3) , the moment of tracheal extubation (T4) , and the moment of exiting the operating room (T5) ; The recovery time of spontaneous respiration, the time of awakening and the time of extubation were counted, and the quality score (steward score) of the awakening was calculated. Exercise and resting visual analog scores (VAS scores) at 2 h, 4 h, 6 h and 8 h after surgery for the two groups of patients were recorded; The number of cases using rescue analgesics after surgery, and the number of times using patient’s self-control intravenous analgesia (PCIA) pumps were counted; The number of patients who experienced adverse reactions (nausea and vomiting, respiratory depression, bradycardia, chills, drowsiness) after surgery were recorded and the incidence rate was calculated. The number of patients was counted and the incidence rate was calculated. Results:The differences in the hemodynamic indexes HR and MAP between the two groups at T0, T1, T2 and T3 were not statistically significant (both P>0.05) . Compared with the control group, the observation group had a significant decrease in the hemodynamic indexes HR at T4 and T5 (101.87 times/min vs 91.67 times/min) (91.53 times/min vs 83.13 times/min) (both P<0.05) . There was no statistically significant difference in the exercise and resting VAS scores between the two groups at 2 h postoperatively (both P>0.05) . Compared with the control group, MAP was significantly reduced in the observation group at T4 and T5 (102.43 mmHg vs 90.4 mmHg) (94.13 mmHg vs 85.53 mmHg) (both P<0.05) . The difference in the exercise and resting VAS scores between the two groups was not statistically significant at 2 h postoperatively (both P>0.05) ; The exercise VAS scores of the patients in the control group at 4 h, 6 h, and 8 h postoperatively were 3.50, 4.70, and 4.63, respectively, and the resting VAS scores of the patients in the control group were 3.43, 4.20, and 4.40; The exercise VAS scores of the patients in the observation group were 2.53, 3.70, and 4.30; The resting VAS scores of patients in the observation group were 2.10, 2.47 (both P<0.05) . In the control group, the number of cases of postoperative rescue analgesic use and the number of patients’ postoperative analgesic pump presses were 2.01±0.73 and 5.87±1.25, respectively; In the observation group, the number of cases of postoperative rescue analgesic use and the number of patients using PCIA pump were 0.43±0.41 and 1.88±0.68, respectively; The number of postoperative rescue analgesic use and the number of patients using PCIA pump were 0.43±0.41 and 1.88±0.68, respectively (both P<0.05) . In the control group, the postoperative recovery time of spontaneous breathing, awakening time and extubation time were 5.67min, 18.77min and 7.40min respectively, while the postoperative spontaneous breathing recovery time, awakening time and extubation time of patients in the observation group were 4.70min, 13.33min and 4.18min, respectively (both P<0.05) . The steward score of the control group was 4.33, and the steward score of the observation group was 5.42 ( P<0.05) . There was no statistically significant difference in the number and incidence of postoperative nausea and vomiting, respiratory depression, bradycardia, chills, or somnolence between the two groups (both P>0.05) . Conclusion:Escitalopram can make the hemodynamics of laparoscopic total hysterectomy patients smooth, reduce postoperative pain, improve the quality of awakening, and reduce adverse reactions.