Application Of Esketamine Compounded With Nalbuphine For Self-controlled Intravenous Analgesia In Postoperative Patients Undergoing Laparoscopic Cholecystectomy

Objective To observe the analgesia,sedation,adverse effects and effects on cognitive function of different doses of esketamine in combination with nalbuphine for intravenous self-administered analgesia in patients after laparoscopic cholecystectomy,and to provide reference for clinical application.Methods A total of 90 patients,aged 18~65 years,ASAI~II,underwent laparoscopic cholecystectomy in the Third Affiliated Hospital of Anhui Medical University(The First People’s Hospital of Hefei)were selected,and the patients were divided into three groups equally by the random number table method.Postoperative PCIA was used in all three groups,with group N given nalbuphine 2mg/kg + saline to 100 ml and groups NE1 and NE2 given 0.5 and 1mg/kg esketamine + nalbuphine 2mg/kg + saline to 100 ml.The patients were observed at 6h(T1),12h(T2),24h(T3)and 48h(T4)postoperatively,with the Visual Analogue Scale(VAS)and Montreal Cognitive Assessment(Mo CA),the Ramsay sedation score,the number of total and effective compressions on the PCIA,the number of adverse reactions and the number of remedial analgesia in the 48 h postoperative period.Results1.The difference in general information between the two groups of patients was not statistically significant(P>0.05).2.In the 24 h postoperative period,resting and motor visual analogue scores were significantly lower in both the NE1 and NE2 groups than in the N group(P< 0.05);comparing the VAS activity pain scores of the three groups at T4,the pain scores were lower in the NE1 and NE2 groups(P< 0.05).At T2 and T3,the VAS activity pain scores were higher in the NE1 group than in the NE2 group(P< 0.05),while the differences at other time points were not statistically significant.3.Ramsay sedation scores were higher in the NE1 and NE2 groups than in the N group at 24 h postoperatively(P<0.05).Ramsay sedation scores were lower in the NE1 group at T1 and T2 compared with the NE2 group(P<0.05).The difference in Ramsay sedation scores at other time points was not statistically significant(P>0.05).4.Comparison between the three groups at each postoperative time point revealed that the total number of compressions and the number of effective compressions with the analgesic pump were significantly less in the NE1 and NE2 groups than in the N group(P<0.05).Compared with the NE1 group,the NE2 group had more effective compressions at the moment of T4(P< 0.05),while the difference was not statistically significant at other time points(P > 0.05).5.Comparing the MoCA scale scores at the preoperative(T0)and T4 moments,there was no statistically significant difference between the three groups(P> 0.05).When the scores at T1、T2 and T0 were compared within groups,the cognitive scores on the Mo CA scale were significantly higher in both the NE1 and NE2 groups than in the N group(P<0.05).The differences between the NE1 and NE2 groups in the Mo CA scale scores at each time point were not statistically significant(P > 0.05).6.The incidence of vomiting in the NE1 and NE2 groups was significantly lower than that in the N group within 48 h postoperatively(P < 0.05),and the difference in the incidence of vomiting between the NE1 and NE2 groups was not statistically significant(P > 0.05).The drowsiness rate in the NE2 group was significantly higher than that in the N and NE1 groups within 48 h after surgery(P < 0.05).There was no statistically significant difference in the incidence of remedial analgesia and other adverse effects among the three groups at different time points after surgery(P>0.05).Conclusion The use of esketamine 0.5mg/kg combined with nalbuphine 2mg/kg for laparoscopic cholecystectomy has satisfactory analgesic effects,is conducive to improving early postoperative cognitive function and reducing the incidence of adverse effects,and is worthy of clinical promotion.