Objective To explore the effects of patient-controlled intravenous analgesia(PCIA) with esketamine combined with ultrasound-guided iliopsoas plane block(IPB) on analgesia and recovery after total hip arthroplasty (THA) in elderly patients.

Methods A total of 82 elderly patients treated with THA were randomly divided into the control group and combination group by computer random number method(41 cases in each group).The control group was treated with ultrasound-guided IPB combined with PCIA, and the combination group was treated with PCIA with esketamine on the basis of control group.The analgesic effect, postoperative recovery, stress index, adverse reactions and joint function were compared between two groups.

Results After 6 h, 24 h and 48 h of operation, the visual analogue scale(VAS) scores in two groups under the motion and resting state gradually decreased, and which in the combination group were lower than that in control group(P < 0.05 to P < 0.01).After surgery, the levels of substance P and cortisol in two groups were higher than those before operatiion, but which in the combination group were lower than those in control group(P < 0.05 to P < 0.01).The rescue rate of analgesia, pressing times of analgesic pump in the combined group were lower than those in control group(P < 0.05 and P < 0.01).There was no statistical significance in the postoperative hospital stay, time of first getting out of bed and adverse reactions between two groups(P > 0.05).After operation, the Harris scores and Bathel index in two groups increased compared with those before operation(P < 0.05), but there was no statistical significance in the Harris scores and Bathel index between two groups after operation(P > 0.05).

Conclusions PCIA with esketamine combined with ultrasound-guided IPB in elderly patients with THA postoperative analgesia can effectively play a role of analgesia and reduce stress, and the medication is safe.