Objective: To investigate the effects of different doses of esketamine combined with ropivacaine on rebound pain after arthroscopic shoulder surgery under superior trunk brachial plexus block.
Methods: Ninety patients, including 35 males and 55 females, aged 18-60 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were selected for shoulder arthroscopy. According to the method of random number table, the patients were divided into three groups: group E1, group E2 and group R, 30 patients in each group. Three groups of patients with nerve block local anesthetic drugs were allocated according to the following scheme. In group E1, 0.2% ropivacaine, esketamine 0.25 mg/kg, and normal saline total 10 ml. In group E2, 0.2% ropivacaine, esketamine 0.5 mg/kg, and normal saline total 10 ml. In group R, 0.2% ropivacaine and normal saline total 10 ml. General anesthesia was implemented for all patients after the nerve block anesthesia. HR, MAP, and surgical pleth index (SPI) were recorded before nerve block (T1), 30 minutes after nerve block (T2), laryngeal mask placement (T3), and 30 minutes during surgery (T4). The NRS scores and the occurrence of rebound pain were recorded at rest and exercise 6, 8, 12, 24, and 48 hours after surgery. The onset time and duration of sensory and motor block after anesthesia, sedation score before and after anesthesia, sleep quality within 24 hours after surgery, and the occurrence of adverse reactions within 48 hours after surgery were recorded.
Results: There were no significant differences in HR and MAP among the three groups at different time points. Compared with group R, the dosage of sufentanil in groups E1 and E2 were significantly reduced, and the NRS score at rest and exercise 12 to 48 hours after surgery were significantly decreased (P < 0.05). Compared with group R, the incidence of rebound pain in group E2 was significantly reduced, and the score of sedation after nerve block was significantly increased, the sleep time was significantly prolonged, and the sleep efficiency was significantly increased within 1 day after surgery (P < 0.05). Compared with group R, the incidence of postoperative adverse reactions such as nausea, vomiting, dizziness and headache in groups E1 and E2 within 48 hours after surgery were significantly reduced (P < 0.05). There were no significant differences in the onset and duration of sensory block among the three groups, and no motor nerve block occurred.
Conclusion: Esketamine 0.5 mg/kg combined with ropivacaine can reduce the incidence of rebound pain after shoulder arthroscopy with brachial plexus block, improve postoperative sleep quality, but cannot shorten the onset time of sensory block and increase the duration of block. |
