Effect of different administration routes of esketamine on postoperative delirium and pain in elderly patients with femoral neck fracture

Wang Wei; Ren Le; Wang Hui; Xu Hui

doi:10.3969/j.issn.1672-8157.2025.05.037

Abstract：Objective To investigate the effect of different administration routes of low-dose esketamine on postoperative de-lirium and postoperative pain in elderly patients with femoral neck fractures.Methods A total of 150 elderly patients with femoral neck fracture treated in Anqing First People's Hospital from January 2022 to June 2024 were selected and randomly divided into an intravenous administration group,a nasal administration group,and a control group,with 50 in each group.All patients under-went standard anesthesia protocols and surgical treatment.All the patients in the three groups received the conventional anesthesia induction and analgesic medication for geriatric femoral neck fracture surgery.The patients in the intravenous administration group received intravenous esketamine in addition to the conventional medication and those in the nasal administration group received intranasal esketamine in addition to the conventional medication.The general information,postoperative pain scores,incidence of postoperative delirium,levels of serum interleukin 6(IL-6)and serum C-reactive protein(CRP),and occurrence of adverse reactions were compared among the three groups.Results At 6,12,and 24 hours after surgery,the pain scores of the intravenous adminis-tration group and nasal administration group((4.31±0.64)points,(3.81±0.55)points,(3.22±0.43)points;(4.65±0.79)points,(4.22±0.54)points,(3.54±0.53)points)were lower than those of the control group((5.29±0.65)points,(4.89±0.57)points,(4.09±0.67)points),and the pain scores of the intravenous administration group were lower than those of the nasal administration group at 6,12,and 24 hours after surgery(F=25.505,48.515,31.754,all P<0.05).On day 1 postoperatively,the incidence of delirium was 4.00%in the intravenous administration group,6.00%in the nasal administration group and 10.00%in the control group(F=0.670,P=0.715).On day 2 postoperatively,the delirium incidence was 2.00%in the intravenous administration group,4.00%in the na-sal administration group and 6.00%in the control group(F=0.391,P=0.832).At 24 h postoperatively,the levels of IL-6((13.25±2.36)pg·mL-1,(14.10±2.64)pg·mL-1)and CRP((8.33±1.24)mg·L-1,(9.41±1.27)mg·L-1)in the intravenous administration group and nasal administration groups were lower than those in the control group(IL-6:(17.54±2.74)pg·mL-1,CRP:(11.31±1.39)mg·L-1)(t=38.610,67.174,both P<0.05).There was no significant difference in IL-6 levels between the nasal administration group and the intravenous administration group(P>0.05).However,the CRP level in the nasal administration group was higher than that in the intravenous administration group(P<0.05).Both the intravenous administration group and nasal administration group showed lower IL-6 and CRP levels at 24 h postoperatively as compared to preoperative levels(t=11.648,8.454,15.531,10.158,all P<0.05),while the control group showed a lower CRP level postoperatively than preoperatively(t=3.134,P<0.05).The specific adverse reactions were as follows:bradycardia 4.00%,nausea/vomiting 6.00%,agitation 4.00%,respiratory depression 0 in the intravenous adminis-tration group;bradycardia 6.00%,nausea/vomiting 6.00%,agitation 4.00%,respiratory depression 2.00%in the nasal administration group;bradycardia 10.00%,nausea/vomiting 2.00%,agitation 6.00%,respiratory depression 2.00%in the control group.There were no significant differences in the incidence of adverse reactions among the three groups(all P>0.05).Conclusion Low-dose es-ketamine administered via both intravenous and nasal routes can effectively reduce postoperative pain and inflammation in elderly patients with femoral neck fracture,with the intravenous route showing superior efficacy.