Effect of pretreatment with esketamine on stress-related hormones in upper limb fracture surgery under brachial plexus block
Hu Juan
Wang Hong
Abstract：Objective To observe the effect of esketamine pretreatment on serum norepinephrine(NE),epinephrine(E)and cortisol(Cor)levels in patients undergoing open reduction and internal fixation for upper limb fracture under brachial plexus block.Methods Seventy-eight patients who underwent open reduction and internal fixation for upper limb fracture under brachial plexus block in Three Gorges Hospital Affiliated to Chongqing University from June 2024 to December 2024 were selected as the research subjects and divided into two groups using random number table methods,with 39 in each group.The patients in the study group were pretreated with esketamine,and those in the control group were given an equal amount of saline.Then the serum NE,E,and Cor levels,inflammatory factors,pain degree and incidence of postoperative adverse events were compared between the two groups at different time points.Results The levels of serum NE,E,and Cor at time points T1,T2,and T3 in the study group and control group were higher than those at time point T0((1.43±0.44)pg·mL-1,(1.54±0.52)pg·mL-1,(1.51±0.49)pg·mL-1,(0.63±0.21)pg·mL-1,(0.72±0.24)pg·mL-1,(0.69±0.30)pg·mL-1,(246.53±58.76)ng·mL-1,(269.67±65.37)ng·mL-1,(279.06±69.41)ng·mL-1,(2.23±1.03)pg·mL-1,(2.98±1.36)pg·mL-1,(2.67±1.19)pg·mL-1,(0.83±0.32)pg·mL-1,(0.93±0.39)pg·mL-1,(0.87±0.34)pg·mL-1,(302.59±75.36)ng·mL-1,(339.64±80.96)ng·mL-1,and(356.49±83.41)ng·mL-1).The levels of serum NE,E,and Cor at time points T1-T3 were increased in both groups,and they were lower in the study group than in the control(P<0.05).The levels of IL-6,TNF-α,IL-2,and CRP in the study group and control group at 12 and 24 hours after operation were higher than those at the time point of T0((67.48±7.96)ng·L-1,(52.36±4.69)ng·L-1,(26.78±6.15)ng·L-1,(19.79±5.78)ng·L-1,(62.38±8.32)pg·mL-1,(53.24±5.12)pg·mL-1,(21.36±3.12)mg·L-1,(14.35±2.56)mg·L-1,(78.96±8.46)ng·L-1,(56.74±5.23)ng·L-1,(32.95±5.67)ng·L-1,(26.36±6.24)ng·L-1,(69.41±9.41)pg·mL-1,(56.34±6.09)pg·mL-1,(24.69±3.34)mg·L-1,(17.97±3.41)mg·L-1),and they were lower in the study group than in the control(P<0.05).The pain levels of the study group and control group at 6 h,12 h and 24 h after surgery((3.79±0.57)points,(3.21±0.61)points,(2.85±0.41)points,(4.25±0.69)points,(3.89±0.74)points,(3.24±0.34)points)were lower than those at 3 h after surgery((3.96±0.72)points,(4.78±0.97)points).The pain levels decreased with time,and they were lower in the study group than in the control(P<0.05).The incidence of adverse reactions in the study group was 7.69%,which was lower than that in the control(28.21%)(P<0.05).Conclusion The esketamine pretreatment for patients undergoing open reduction and internal fixation for upper limb fracture under brachial plexus block is effective because it can effectively reduce serum NE,E,and Cor levels,attenuate inflammatory response,alleviate pain,and reduce incidence rate of postoperative adverse effects.
Keywords：EsketamineBrachial plexus blockNorepinephrineAdrenalineCortisol
Publication Date：2025-06-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 519-522 )