Objective: To investigate the effect of different doses of esketamine combined with hydromorphone postoperative patient-controlled intravenous analgesia (PCIA) on depression in elderly patients undergoing total knee arthroplasty.
Methods: A total of 180 elderly patients, 44 males and 136 females, aged 65-80 years, BMI 18.5-35.0 kg/m2, ASA physical status Ⅱ or Ⅲ, undergoing total knee arthroplasty (TKA) under elective general anesthesia combined with adductor block from July 2023 to September 2023. Patients were divided into three groups by random number table method: control group (group C), esketamine 0.5 mg/kg group (group E1), and esketamine 1.0 mg/kg group (group E2), 60 patients in each group. After operation, groups C, E1 and E2 were given hydromorphone 0.2 mg/kg, esketamine 0.5 mg/kg combined with hydromorphone 0.2 mg/kg, and esketamine 1.0 mg/kg combined with hydromorphone 0.2 mg/kg to receive PCIA, respectively, and the three groups were diluted to 100 ml with normal saline. Parameters were set as follows. The background infusion rate was 1.5 ml/h, and the single press dose was 1.5 ml, and the locking time was 15 minutes. If the VAS pain score at rest was greater than or equal to 4 points and the analgesic effect of pressing the PCIA pump was not effective, then intramuscular injection of tramadol 0.1 g was used for remedial analgesia. Hamilton depression scale (HAMD) score was performed 1 day, 3 and 7 days after surgery. Depressive state was classified as having HAMD score ≥ 8 points. VAS pain scores at rest were performed 1 day, 3 and 7 days after surgery. The number of depression within 7 days after surgery, the number of effective (D1) and total (D2) pump compressions and D1/D2 within 3 days after surgery, the number of rescue analgesia, the occurrence of adverse reactions such as tramadol dosage, dizziness, headache, multiple dreams, hallucinations, nausea and vomiting were recorded.
Results: Twenty-one patients (35%) in group C experienced depression, 7 patients (12%) in group E1, and 8 patients (13%) in group E2 during 3 days after surgery. Eight patients (13%) in group C experienced depression, 1 patients (2%) in group E1, and 2 patients (3%) in group E2 during 7 days after surgery. Compared with group C, the incidence of depression 3 and 7 days after surgery, rescue analgesia rate in group E1 were significantly decreased, the incidence of depression 3 and 7 days after surgery, dizziness, headache, and dreaminess within 3 days after surgery in group E2 were significantly decreased (P < 0.05). There were no significant differences in the incidence of depression and VAS pain scores between group E1 and group E2 at 1, 3, and 7 days after surgery.
Conclusion: Esketamine 0.5 and 1.0 mg/kg for PCIA in elderly patients after TKA can improve postoperative depression, while esketamine 1.0 mg/kg can reduce the incidence of postoperative dizziness, headache, and multiple dreams. |
