Analysis of safety and efficacy of perioperative esketamine in elderly patients undergoing hip arthroplasty

ObjectiveTo observe the safety and efficacy of perioperative esketamine in elderly patients with hip arthroplasty.

MethodsNinety elderly patients scheduled for hip arthroplasty were randomly divided into group S and group E, 45 cases in each group.The patients in group S received ultrasonic-guided anterior lumbar and sacral plexus nerve block, and midazolam and sufentanil injection were slowly injected intravenously 5 minutes before skin cutting, and sufentanil injection was used as patient-controlled intravenous(PCIA) pump for postoperative analgesia.The patients in group E received ultrasonic-guided anterior lumbar and sacral plexus nerve block, and midazolam and esketamine were slowly injected intravenously 5 minutes before skin cutting, and esketamine was used as a PCIA pump for analgesia.The number of cases of body movement reaction during skin cutting(T₁), the change value of MAP 5 min utes after skin cutting(T₂)(△MAP) and the incidence of intraoperative respiratory depression were observed and compared between the two groups.The change of interleukin-6(IL-6) and cortisol(Cor) before operation(T₀) and 6, 12, 24 h after operation(T₃, T₄, T₅) were also tested.Visual analogue scale(VAS) and Ramsay sedation score at 6, 12, 24 h after surgery(T₃, T₄, T₅), the changes of Mini-mentul State Examination(MMSE), the total number of PCIA compressions and the incidence of nausea and vomiting at 1 and 3 days after surgery(T₅ and T₆) were recorded.

ResultsThe △MAP at T₂ in group E was lower than that in group S(P < 0.05).There was no statistical significance in the incidence of the number of cases of body movement reaction at T₁ and intraoperative respiratory depression between the two groups(P>0.05).There was no statistical significance in the concentration of IL-6 and Cor between the two groups before operation(P>0.05), however, both the concentration in group E was significantly lower than that of group S at each time point after operation(P < 0.01).There was no significant difference in VAS score between the two groups at T₃(P>0.05), but the VAS score in group E was significantly lower than that in group S at T₄ and T₅(P < 0.01).Ramsay score in group E was significantly lower than that in group S at each time point(P < 0.01), and MMSE score of cognitive state at T₅ and T₆ was significantly higher than that in group S(P < 0.01).The total number of PCIA compressions and the incidence of nausea and vomiting in group E were lower than those in group S(P < 0.05).

ConclusionsEsketamine used in elderly patients with hip arthroplasty can significantly reduce perioperative complications, effectively inhibit inflammatory response, provide good analgesic effect, and also have slight effect on postoperative cognitive function of patients.