Effects of Esmketamine pretreatment on postoperative pain, circulatory and respiratory function and inflammatory factors in elderly patients with brachial plexus block / 中华老年医学杂志

ABSTRACT

Objective:To investigate the effects of Esmketamine pretreatment on postoperative pain, circulatory and respiratory function and inflammatory factors in elderly patients undergoing brachial plexus block.Methods:A total of 98 patients with rotator cuff injuries admitted to our hospital from December 2019 to December 2020 were prospectively divided into the control group and the Esmketamine pretreatment group, with 49 cases in each group.The Esmketamine pretreatment group was given 0.5 mg/kg of Esmketamine intravenously, and the control group was given the same amount of normal saline intravenously.General data, postoperative pain, circulatory and respiratory function, postoperative inflammatory factor levels and adverse reactions were compared between the two groups.Results:Intraoperative Ramsay sedation scores(RSS)at 30 min, 60 min and 90 min had no significant difference between the Esmketamine pretreatment group and the control group(all P>0.05). Visual analogue scale(VAS)scores at 12 h and 24 h after surgery were lower in the Esmketamine pretreatment group than in the control group(all P<0.05). The VAS scores showed differences between the two groups at different time points(all P<0.05)and there were also signs of interaction effects.The mean arterial pressure(MAP), heart rate(HR), oxyhaemoglobin saturation by pulse oximetry(SpO 2)and respiratory rate(RR)at T1, T2 and T3 were lower in the ESM-ketamine pretreatment group than in the control group(all P<0.05). Compared with the control group, the Esmketamine pretreatment group had lower levels of interleukin-6(IL-6)[(198.74±21.50)mmol/L vs.(272.69±19.74)mmol/L, t=17.537, P<0.001], C-reactive protein(CRP)[(11.65±2.51)mg/L vs.(15.79±3.27)mg/L, t=7.972, P<0.001], tumor necrosis factor-α(TNF-α)(25.71±10.27 ng/L vs.34.65±9.81 ng/L, t=10.113, P<0.001), β-endorphin[(1.69±0.27)ng/L vs.(2.18±0.35)ng/L, t=8.815, P<0.001]and neuron-specific enolase(NSE)[(8.48±0.93)ng/L vs.(13.57±1.89)ng/L, t=9.846, P<0.001]at 24 h after surgery.The total incidence of adverse reactions was also lower in the ESM-ketamine pretreatment group than in the control group(16.3% vs.8.2%, χ2=3.129, P=0.047). Conclusions:Esmketamine pretreatment in brachial plexus block can provide good analgesic effects, has limited impact on circulatory and respiratory function, and can effectively reduce the levels of inflammation and adverse reactions in elderly patients.