Effect of esketamine combined with glossopharyngeal nerve block on emergence agitation after tonsillectomy in children

RUAN Wenliang; WEI Peng

doi:10.3969/j.issn.1002-266X.2025.01.014

Abstract：Objective To investigate the effect of esketamine combined with ultrasound-guided glossopharyngeal nerve block on emergence agitation(EA)during the recovery period following pediatric tonsillectomy.Methods Totally 105 children undergoing tonsillectomy were selected and randomly divided into three groups(G,S,and C)using a ran-dom number table,with 35 patients in each group.In the group S,esketamine 0.25 mg/kg was intravenously adminis-tered during anesthesia induction.Children in the groups G and C received an equivalent volume of normal saline.Follow-ing induction,children in both the group G and group S received glossopharyngeal nerve blocks.Anesthetic induction and maintenance methods were consistent across all groups.Emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium(PAED)scale at extubation(T2),10 minutes after extubation(T3),20 minutes after extubation(T4),and 30 minutes after extubation(T5).Sedation levels were evaluated using the Ramsay Sedation Scale(RSS),and pain levels were assessed using the Face,Legs,Activity,Cry,Consolability(FLACC)scale.Serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay(ELISA)at pre-anesthesia(T0)and immediately post-surgery(T1).Heart rate(HR)and mean arterial pressure(MAP)were recorded at T2,T3,T4,and T5 for all groups.Postoperative rescue sedation and analgesia usage were documented,as well as the ad-verse reactions within 24 h after surgery.Results The incidence of emergence agitation in groups C,G,and S was 51.43%(18/35),22.86%(8/35),and 5.71%(2/35),respectively,with statistically significant differences between the groups(all P<0.05).PAED scores gradually decreased at T2,T3,T4,and T5 in all three groups.Compared with group C,the PAED scores in the groups G and S were lower at T2,T3,T4,and T5(all P<0.05).Additionally,PAED scores in the group S were lower than those in the group G at T2,T3,T4,and T5(all P<0.05).Group G and group S had significantly higher Ramsay scores than the group C at T2,T3,T4,and T5(all P<0.05),and Group S had significantly higher Ramsay scores than the group G at T2,T3,T4,and T5(all P<0.05).FLACC scores gradually decreased in all groups from T2 to T5.Group G and group S had significantly lower FLACC scores than the group C at T2,T3,T4,and T5(all P<0.05),and Group S had lower FLACC scores than the group G at all time points(all P<0.05).At T0,there were no significant differences in the serum IL-6 or TNF-α levels among the three groups(all P>0.05).At T1,the serum IL-6 and TNF-α levels in all groups were higher than those at T0(all P<0.05).Group G and group S had significantly lower se-rum levels of IL-6 and TNF-α than the group C at T1(all P<0.05).Group S had significantly lower lower IL-6 and TNF-α levels than the group G at T1(all P<0.05).At T2,T3,T4,and T5,there were no significant differences in heart rate(HR)and mean arterial pressure(MAP)either within or between groups(all P>0.05).There were significant differences in the postoperative rescue sedation and rescue analgesia rates among the three groups(all P<0.05).The rescue sedation and analgesia rates were lower in the groups G and S than in the group C(all P<0.05),but there were no significant differ-ences between groups G and S(all P>0.05).No adverse reactions such as bleeding,laryngeal spasm,or hoarseness oc-curred in the three groups within 24 h postoperatively.There were no significant differences in the incidence of nausea and vomiting,respiratory depression,or foreign body sensation in the throat(all P>0.05).Conclusion Glossopharyngeal nerve block combined with esketamine significantly reduces the incidence of emergence agitation in children after tonsillec-tomy,improves the effects of sedation and analgesia,alleviates inflammatory responses,and does not increase the inci-dence of adverse reactions.