Effects of two doses of esketamine combined with ropivacaine on brachial plexus block in patients with humeral fractures

WU Jian; ZHOU Kai

doi:10.3969/j.issn.2096-2681.2025.03.006

Abstract：Objective To compare the effects of two different doses of esketamine combined with ropivacaine on brachial plexus block in patients with humerus fractures.Methods Ninety patients of either gender,aged 22-69 years old,with a body weight of 50-85 kg,of American Society of Anesthesiologists(ASA)Physical Status classification Ⅰ or Ⅱ,with unilateral humeral shaft fracture who underwent open reduction and internal fixation through intermuscular groove brachial plexus block at Zibo 148th Hospital from January to December 2023 were selected as the study objects.Patients were divided into three groups by random number table method:0.5％ropivacaine 20 mL group(group R,n=30),10 mg esketamine+0.5％ropivacaine 20 mL group(group S1,n=30),20 mg esketamine+0.5％ropivacaine 20 mL group(group S2,n=30).The onset time of sensory block,onset time of motor block,duration of sensory block,duration of motor block,visual analogue scale(VAS)scores at rest and during activity at 8,10,12,24 and 48 h after surgery were recorded in the three groups.The incidence of"rebound pain"within 48 h,the number of patient controlled intravenous analgesia(PCIA)compressions,the number of remedial analgesia cases,and the satisfaction of postoperative analgesia were recorded.The occur-rence of postoperative adverse reactions was observed.Results Compared with group R,the onset time of sensory block and motor block in group S1 and group S2 were faster and the duration were longer(P＜0.05).Patients in the group S1 and group S2 had lower VAS scores at rest and activity at 8,10,and 12 h postoperatively than those in the group R(P＜0.05).The incidence of"rebound pain",the number of PCIA compressions,and the number of cases of tramadol rescue analgesia in group R patients within 48 h after surgery were higher than those in group S1 and group S2(P＜0.05);the incidence of adverse reactions in group S1 was lower than that in group S2(P＜0.05).Conclusion A 10 mg dose of esketamine can shorten the onset time of brachial plexus block,prolong the postoperative analgesic duration,decrease the occurrence of"rebound pain",and is associated with fewer postoperative adverse effects,and has a rela-tively high satisfactron rate in pain relief.