Effect Of Esketamine On Postoperative Depression In Elderly Patients With Total Hip Arthroplasty

Purpose:With the increasing aging of the global population,the incidence of hip fracture in elderly patients is increasing year by year.Femoral neck fracture is the main type of hip fracture,and most patients choose total hip arthroplasty for treatment.However,chronic pain,anxiety and depression symptoms are often associated with this group during perioperative period,thus affecting the prognosis and prolonging the recovery time to a certain extent.Most studies have found that there is a close and complex relationship between pain and bad mood,therefore,it is very important to choose a reasonable analgesic for total hip replacement.Ketamine is a kind of NMDA receptor inhibitor,which has sedative,analgesic and anti-depression effects.However,its clinical application is widely limited due to its easy induction of postoperative delirium,cognitive impairment and numerous psychiatric side effects.Esketamine,as the right monomer of ketamine,has stronger anesthetic and antidepressant effects,and has been proven to reduce the toxic side effects of ketamine,it has been widely used in clinic in recent years,therefore,this study compared the postoperative analgesia of esketamine with the traditional opioid analgesic drug sufentanil to observe its analgesic effect and whether it can reduce the postoperative anxiety and depression symptoms of patients,so as to accelerate the postoperative recovery of patients and shorten the length of hospital stay.Methods:After approval by the medical ethics committee of the hospital,132 patients who underwent total hip replacement due to femoral neck fracture in our hospital from January 2022 to August 2022 were randomly selected as the study subjects.According to the computer generated random number table,they were randomly divided into esketamine group(group A)and sufentanil group(group B),with 67 cases in group A and 65 cases in group B.All patients underwent general anesthesia,and conventional anesthesia was induced and maintained.After surgery,the two groups underwent ultrason-guided iliac fascia space block,and were given 10 m L 1% ropivacaine + 10 m L 2% lidocaine + 10 m L normal saline.The intravenous electronic analgesia pump was also connected.The dose of esketamine was 2.5 mg/kg in group A,and sufentanil was given 2.5 μg/kg in group B,dissolved in normal saline to 100 ml.Baseline data of the two groups were collected respectively.Visual analogue score(VAS)was recorded at 2 h,4 h,12 h,24 h,48 h for resting and 12 h,24 h,48 h for active VAS.The first time to get out of bed,the distance to get out of bed and PCA compression times were recorded within 48 hours after surgery.The incidence of postoperative adverse reactions such as nausea,vomiting,dizziness,pruritus and multilingual was recorded.Serum IL-6 and CRP levels were detected by enzyme-linked immunosorbent assay(ELISA)in the morning,24 h and 72 h after surgery.Hospital Anxiety and Depression Scale(HAD)scores and Harris hip scores were followed up 3 days,1 week and 1 month after surgery.Results:In total,data from 132 patients were included for analysis.The results of the study showed that:1.Comparison of general data between the two groups: there was no statistical significance between the two groups in terms of baseline characteristics(age,gender,BMI,ASA grading,chronic disease history,hospitalization cost,operation time,occupational status,educational level,preoperative HAD score and preoperative Harris score)(P>0.05).2.Comparison of pain scores(VAS scores): There was no significant difference between the two groups in the resting and dynamic VAS scores within 48 h after surgery(P>0.05).3.Comparison of recovery condition,hospital stay and PCA compression times:(1)The first time to get out of bed,activity distance and hospitalization days of group A were better than those of group B,the difference was statistically significant(P<0.05);(2)There was no significant difference in the number of PCA compressions between the two groups(P>0.05).4.Comparison of postoperative adverse reactions: the incidence of nausea,vomiting and dizziness in group B was higher than that in group A,the difference was statistically significant(P<0.05),while the incidence of pruritus and multilingual was not statistically significant(P>0.05).5.Comparison of stress indexes:(1)There was no significant difference in IL-6 and CRP levels between the two groups in the morning of the operation day(P>0.05).(2)At 24 h and 72 h after operation,IL-6 and CRP levels in group A were lower than those in group B,with statistical significance(P<0.05).6.HAD scores comparison:(1)The anxiety and depression scores of group A at 3 days and 1 week after surgery were lower than those of group B,the difference was statistically significant(P<0.05);(2)There was no significant difference in anxiety and depression scores 1 month after surgery between the two groups(P>0.05).7.Comparison of Harris scores: The comparison of Harris scores 3 days,1 week and 1 month after surgery in group A was higher than that in group B,with statistical significance(P<0.05).Conclusions:Esketamine postoperative analgesia can improve perioperative anxiety and depression symptoms in elderly patients with total hip replacement,effectively alleviate adverse reactions associated with opioids,optimize postoperative analgesia,reduce perioperative stress reaction,and thus shorten the bed time of such patients and accelerate postoperative recovery.