Effect of Analgesia with Subanesthetic Dose of Esketamine on Postoperative Delirium in Patients with Frailty Undergoing Hip Arthroplasty

XIN Wenqi; CHENG Qianyi; FENG Meijie; CHEN Pan; MIN Menghang

doi:10.3969/j.issn.1004-437X.2026.12.007

Abstract：Objective To observe the effect of postoperative analgesia with subanesthetic dose of esketamine on postoperative delirium(POD)in frail patients undergoing hip arthroplasty.Methods A total of 126 patients with frailty,American Society of Anesthesiologists physical status Ⅱ or Ⅲ,no limitation in age and gender,body mass index 18-25 kg·m-2,who underwent total hip arthroplasty were randomly assigned to esketamine group(group E)and sufentanil group(group S),63 patients in each group.All patients underwent general anesthesia.Postoperative analgesia was provided via patient-controlled intravenous analgesia(PCIA).Group E received esketamine 2.5 mg·kg-1,while group S received sufentanil 2.5 μg·kg-1,both were diluted to 100 mL with normal saline.The confusion assessment method-Chinese revision(CAM-CR)scores for delirium from 1 day preoperatively to postoperative days 1-7,and the incidence of POD during hospitalization were recorded.Postoperative visual analogue score(VAS),PCIA press counts,and adverse reactions were also recorded.Pittsburgh sleep quality index(PSQI)and Athens insomnia scale(AIS)scores were assessed.Melatonin and cortisol concentrations were measured on the day of surgery and on postoperative days 1,2,and 3.Results The CAM-CR scores for delirium on postoperative days 1-4 and the incidence of POD during hospitalization were lower in group E compared to group S(P＜0.05).There were no significant differences in postoperative VAS scores or PCIA press counts between the two groups(P＞0.05).PSQI and AIS scores on the first and second postoperative nights were lower in group E compared to group S(P＜0.05).Melatonin levels on postoperative days 1,2,and 3 were higher in group E,while cortisol levels on these days were lower compared to group S(P＜0.05).Compared with group S,the incidence of nausea,vomiting and dizziness in group E was lower,and the difference was statistically significant(P＜0.05).However,there was no statistically significant difference in the incidence of skin itching and polysomnography between the two groups(P＞0.05).Conclusion PCIA with a subanesthetic dose of esketamine can reduce the incidence of POD,provide effective postoperative analgesia,improve sleep quality in frail patients after hip arthroplasty,and accelerate postoperative recovery.