Effects Of Low-dose Esketamine On Postoperative Pain And Sleep Quality Post Thoracoscopic Surgery

Objective:To study the effect of low dose esketamine on postoperative acute pain,sleep quality and adverse reaction in patients undergoing thoracoscopic operation.The safety of esketamine were also evaluated to provide certain reference on comfortable thoracoscopic surgery anesthesia.Methods:96 patients undergoing thoracoscopic pulmonary mass resection were selected and grouped to esketamine group（group E）or control group（group C）equally.Group E underwent routine anesthesia induction,penehyclidine hydrochloride 0.3 mg,sufentanil 0.5μg/kg,propofol 1.5mg/kg,cis-atracuramide 0.2mg/kg and esketamine 0.2mg/kg.The anesthesia induction protocol in group C was the same as before,the esketamine was displaced with a uniform volume of normal saline finally.Anesthesia maintenance:intravenous infusion of remifentanil 1～2μg/（kg.min）,cis-atracurium 4-6mg/h and inhalation sevoflurane 1.5-3.0vol%persistently.After the operation,the patients was sent to the anesthesia recovery unit for observation.Postoperative analgesia regimen:intercostal nerve block combined with patient-controlled intravenous analgesia.If the patients would experience moderate or above pain（VAS≥4）,they were intravenously injiected tramadol 50 mg for rescue analgesia.Pressure pain threshold,the preoperative（T₀）expectation of postoperative pain,sleep quality（PSQI Pittsburgh Sleep Quality Index）,perioperative 40 items of quality of recovery（Qo R-40）were recorded.The heart rates and mean arterial pressure at rest 10min after entering the operating room（T₁）,intubation（T₂）,artificial pneumothorax establishment（T₃）,intercostal nerve block completion（T₄）and extubation（T₅）,perioperative vasoactive drug use,and total use of sevoflurane and remifentanil were recorded.VAS scores at 2h(T₆,VAS and Qo R-40 at 24h（T₇）and 48h（T₈）after operation,sleep quality score（ISI）at 48h postoperation were recorded.Rescue analgesia rates at 24h after operation,incidence rate of postoperative adverse reactions were also observed.Results:（1）The rate of preoperative sleep disturbance in thoracic operation patients was 51.04%,the incidence of sleep disorder before discharge was 58.33%,and 28.13%of patients expected to have moderate or more postoperative pain after surgery;（2）Preoperative PSQI score was positively correlated with postoperative ISI score（P<0.05）;（3）The number of patients with sleep disorders in group E was little than that in group C（P<0.05）;（4）The peak of postoperative pain after thoracoscopy lung surgery was 24h after operation,the pain score of group E at postoperative 24h was lower than that of group C（P<0.05）;（5）The pain experience score,emotional state score and total score of Qo R-40 were higher in group E at T8（P<0.05）;（6）Compared with group C,the use rate of norepinephrine was significantly lower（P<0.05）in group E,the trend of mean arterial pressure,and heart rate is relatively stable;（7）There was no significant difference between the consumption of remifentanil and sevoflurane between the two groups;（8）The rescue analgesia rate at 24h after operation in group E was lower than group C（P<0.05）.The incidence of adverse reactions in group E after operation was about to similar with group C.Conclusion:（1）In patients undergoing thoracoscopic surgery,a single intravenous administration of low-dose esketamine during induction of general anesthesia is more stable in hemodynamics,which reduces the use of norepinephrine during the operation;（2）Low-dose esketamine can release postoperative acute pain and improved postoperative sleep quality of patients;（3）Low dose esketamine is safe for thoracoscopic surgery and will not increase esketamine related drug adverse reactions.