Sub-anesthetic Dose Of Esketamine For Postoperative Analgesia In Thoracoscopic Lobectomy

Objective:To investigate the effect of a sub-anaesthetic dose of esketamine on postoperative opioid use and acute and chronic postoperative pain in patients undergoing thoracoscopic lobectomy.Methods:One hundred patients who underwent elective thoracoscopic lobectomy under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to March2022 were selected and divided into the remifentanil combined with esketamine group(test group)and the remifentanil alone group(control group)according to the random number table method,with 50 cases in each group.Both groups were given intravenous anesthesia,and propofol and remifentanil injections were pumped to maintain anesthesia after routine induction.In the test group,esketamine was administered intravenously at 0.25mg/kg before skin incision and continuously pumped at 0.15 mg/(kg·h)during the operation,and stopped30 minutes before the end of the operation.The two groups of patients were compared in terms of resting and post-active visual analogue scores(VAS)at 4h(T0),8h(T1),12h(T2),24h(T3)and 48h(T4)postoperatively;the cumulative amount of sufentanil in the intravenous self-administered analgesia(PCIA)pump,the time of first pump press,the number of pump presses within 24 hours;the occurrence of adverse reactions,satisfaction with analgesia and overall evaluation.Leeds Neuropathic Symptoms and Signs Pain Score(LANSS)were recorded at 1 day,1 month and 3 months postoperatively.Results:The cumulative amount of sufentanil in the PCIA was(81.30±2.39)μg in 24 h in the test group compared to(89.67±3.88)μg in the control group(P<0.05).The VAS scores at T0,T1 and T2 in the test group were significantly lower than those in the control group(P<0.05).In the test group,the time to first press of the pain pump was later,compared to the control group[(85.46±10.76)min vs.(41.12±13.83)min,P<0.05],and the effective press of the pain pump in 24 h was less than [(6.20 ± 1.59)vs.(11.78 ± 2.58),P< 0.05].The difference in adverse effects between the two groups was not significant(P>0.05).Postoperative patient satisfaction and overall evaluation of analgesia were higher in the test group than in the control group(P<0.05).LANSS scores at 1 day,1 month and 3 months postoperatively were lower in the test group than in the control group[(11.38±2.05)vs.(15.06±1.89),(8.62±1.63)vs.(12.70±1.28),(6.50±1.56)vs.(11.16±1.73),P<0.05].Conclusion:The sub-anaesthetic dose of esketamine reduces acute pain in patients after thoracoscopic lobectomy,reduces the use of postoperative opioids and does not increase the adverse effects in patients.It has a certain significance in alleviating neuropathic pain.