Clinical observation of the effect of esketamine on remifentanil-induced hyperalgesia

GE Qian; ZHAO Shiling; QI Xiaotong; WEN Chao

doi:10.3969/j.issn.2096-2681.2024.01.002

Abstract：Objective To observe the effect of low-dose esketamine on hyperalgesia induced by remifentanil before operation.Methods A total of 100 ASA Ⅰ or Ⅱ patients,aged 21-69 years,with body mass index 18-28 kg/m2,were randomly divided into es-ketamine group(group A,n=50)and blank control group(group B,n=50),the operation time of both groups were longer than 60 mi-nutes.Then the upper limb venous access was obtained.Both groups were induced with midazolam 0.03 mg/kg,sufentanil 0.4 μg/kg,etomidate 0.2 mg/kg,0.6 mg/kg.Group A were injected with escitalopram ketamine 0.3 mg/kg,and group B were injected with same volume of normal saline.Propofol 2 mg/(kg·h)and remifentanil 0.1 μg/(kg·min)were continuously injected by pump.Rocuronium was added continuously.Non-dominant hand forearm and mechanical pain threshold of skin incision of patients were measured before the op-eration.VAS scores were recorded 2,4,8,12,24 h after the operation.The non-dominant hand forearm and mechanical pain threshold of skin incision were measured 24h after the operation and the rating scales were collected.The occurrence of mental symptoms of both groups such as dizziness(reported by the patients),orientation(correct),calculation ability(correct),diplopia,dreaminess,delirium and so on were recorded.Results There was significant difference between group A and group B in the mechanical pain threshold of non-dominant hand forearm and skin of surgical incision(P＜0.05).There was no significant difference in VAS score between group A and group B(2,4,8,12,24 h)after operation(P＞0.05).There was no significant difference in perianesthesia psychiatric symptoms(dizziness,ori-entation,calculation ability,diplopia,dreamlike and delirium)between groups A and group B(P＞0.05).Conclusion Preoperative application of low-dose esketamine(0.3 mg/kg)can effectively inhibit remifentanil hyperalgesia,improve the quality of recovery period,and improve perioperative patient satisfaction.