Objective: To explore the effect of esketamine combined with dexmedetomidine opioid-free anesthesia (OFA) on early postoperative pain following arthroscopic anterior cruciate ligament reconstruction (ACLR).
Methods: Patients aged 18-64 years and ASA physical status Ⅰ-Ⅱ scheduled for arthroscopic ACLR under general anesthesia were enrolled. Patients were randomly allocated to two groups: the OFA group (group F) and the opioid-based anesthesia group (group O) by using a random-number table. Both groups underwent general anesthesia with laryngeal mask airway combined with femoral nerve block. In group F, anesthesia induction included an infusion of dexmedetomidine 0.5 μg/kg and esketamine 0.5 mg/kg, while maintenance involved an infusion of dexmedetomidine 0.5 μg·kg-1·h-1 and esketamine 0.2-0.3 mg·kg-1·h-1. In group O, anesthesia induction involved intravenous fentanyl 4 μg/kg, and maintenance involved an infusion of remifentanil 0.2-0.7 μg·kg-1·min-1. The primary outcome was the area under the curve (AUC) of VAS at rest within 48 hours postoperatively. Secondary outcomes included the AUC of VAS pain scores during movement within 48 hours postoperatively; HR and MAP at the following time points: upon room entry, 1 minute after induction, at laryngeal mask insertion, at 30 and 60 minutes after tourniquet inflation, and at laryngeal mask removal; time to first rescue analgesia, times of rescue analgesia requests postoperatively, extubation time, time to recovery of orientation. Adverse reactions included intraoperative hypertension, hypotension, tachycardia, bradycardia, and postoperative dizziness and nausea/vomiting within 48 hours postoperatively.
Results: This study ultimately included 68 patients, 33 patients in group F and 35 patients in group O. Compared with group O, group F showed a significantly smaller AUC for VAS scores both at rest and during activity within the first 48 hours postoperatively. Compared with group O, group F had a significantly higher MAP 1 minute after induction and laryngeal mask insertion, but a significantly lower MAP 60 minutes after tourniquet inflation. Compared with group O, group F had a significantly longer time to first rescue analgesia, required significantly fewer rescue analgesia doses, and had longer extubation times and time to recovery of orientation. The incidence of intraoperative hypotension was significantly lower in group F compared with group O (P < 0.05). There was no statistically significant difference in adverse reactions such as intraoperative hypertension, tachycardia, bradycardia, postoperative nausea and vomiting and dizziness between the two groups.
Conclusion: OFA using esketamine combined with dexmedetomidine can be effectively used in arthroscopic ACLR. Compared to traditional opioid-based anesthesia, this OFA regimen provides superior postoperative analgesia and more stable blood pressure, among other advantages. |
