The effects of esmketamine combined with butorphanol tartrate on pain mediators and inflammatory stress response in elderly patients with femoral neck fracture undergoing total hip replacement

Li Xinghui; Zhang Bifeng; Zhao Wei

doi:10.3760/j.issn.1673-4777.2025.08.014

Abstract：Objective To investigate the effects of esmketamine combined with butorphanol tartrate on pain mediators and inflammatory stress response in elderly patients with femoral neck fracture undergoing total hip replacement.Methods A total of 112 elderly patients with femoral neck fracture who underwent total hip arthro-plasty in the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from September 2022 to September 2024 were selected as the research objects.A total of 112 patients were divided into observation group and control group by random number table method,with 56 cases in each group.The control group was given butorphanol tartrate patient-controlled intravenous analgesia,while the observation group was given esketamine combined with butorphanol tartrate patient-controlled intravenous analgesia.The postoperative analgesia and seda-tion scores,pain mediators,inflammatory factors,stress response and the total incidence of adverse reactions were compared between the two groups.Results The Visual Analogue Scale scores of the two groups at 2,6,12 and 24 h after operation were gradually decreased,and those in the observation group were lower than those in the control group at each time point.The Ramsay sedation scores of the observation group were gradually increased,and those in the observation group were higher than those in the control group at each time point(all P＜0.001).The levels of prostaglandin E2,substance P,and β-endorphin in the two groups 24 h after operation were higher than those before operation,but those in the observation group were lower than those in the control group[(49±6)μg/Lvs(52±5)μg/L,(61±6)μg/L vs(65±6)μg/L,(130±13)μg/L vs(138±15)μg/L](all P＜0.05).The levels of tumor necrosis factor-α,interleukin-6,epinephrine,norepinephrine and cortisol in the two groups at 24 h after operation were higher than those before operation,but those in the observation group were lower than those in the control group.The level of interleukin-10 in the observation group was higher than that in the control group(all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Esmketamine combined with butorphanol tartrate has a good analgesic and sedative effect on elderly patients with femoral neck fracture undergoing total hip replacement.It can reduce the levels of pain mediator,tumor necrosis factor-α and interleukin-6,increase the level of interleukin-10,and reduce the stress response.