不同剂量艾司氯胺酮对胸腔镜下肺部分切除术患者瑞芬太尼诱发痛觉过敏的影响

doi:10.13481/j.1671-587X.20240526

Abstract

Abstract:

Objective To compare the preventive effects of different doses of esketamine on remifentanil-induced hyperalgesia （RIH） in the patients underwent thoracoscopic pnlmonary lobectomy， and to provide the basis for the multimodal analgesia and rapid postoperative recovery. Methods The prospective， double-blind，parallel-designed randomized controlled trial （RCT） were conducted， and 107 patients who underwent visual-assisted thoracoscopic pulmonary lobectomy were included. The patients were randomly divided into normal control group，low dose of esketamine group，and high dose of esketamine group using random number methods. Except the patients who were eliminated and those who dropped out of the study，there were 31 patients in normal control group，33 patients in low dose of esketamine group，and 33 patients in high dose of esketamine group.The patients in low dose of esketamine group were given the intravenous injection of 0.25 mg·kg^－1 esketamine （diluted to 5 mL） during anesthesia induction；the patients in high dose of esketamine group were given the intravenous injection of 0.50 mg·kg^－1 esketamine （diluted to 5 mL）， and the patients in normal control group were given 5 mL intravenous injection of saline. The mechanical pain thresholds of the non-dominant forearm skin and skin around the surgical incision at different time points， numeric rating scale （NRS） scores， Ramsay sedation scores， perioperative analgesic drug dosages， and the incidences of adverse reactions such as postoperative delirium， nausea， and vomiting of the patients in various groups were recorded. Results Compared with normal control group， the mechanical pain thresholds around the surgical incision skin of the patients in low and high doses of esketamine groups were increased （P<0.05）； compared with low dose of esketamine group， the extubation time of the patients in high dose of esketamine group was increased（P<0.05）. Two minutes after anesthesia induction administration， compared with normal control group， the mean arterial pressure（MAP） and heart rate（HR） of the patients in low and high doses of esketamine groups were increased （P<0.05）， but there were no significant differences in the MAP and HR of the patients between low dose of esketamine and high dose of esketamine group （P>0.05）；compared with normal control group， the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased （P<0.05）， while there were no significant differences in the incidences of above adverse reactions in low dose of esketamine group （P>0.05）； compared with low dose of esketamine group， the incidences of hallucinations and delirium among the patients in high dose of esketamine group were increased （P<0.05）. Conclusion Intravenous administration of esketamine with a dosage of 0.25 mg·kg^－1 during anesthesia induction improves the postoperative mechanical pain threshold of the patients undergoing thoracoscopic pulmonary lobectomy， which exhibits effective prevention of RIH without an increase in incidences of adverse reactions during the perioperative period.

Key words: Esketamine, Remifentanil, Hyperalgesia, Thoracic surgery, Anesthesia induction

CLC Number:

R614.2

Ruikun WANG,Zongsheng DUAN,Wenwen ZHANG,Hushan WANG. Effects of different doses of esketamine on remifentanil-induced hyperalgesia in patients underwent thoracoscopic pulmonary lobectomy[J].Journal of Jilin University(Medicine Edition), 2024, 50(5): 1406-1413.

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References 23

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Group	n	Gender (Male/female)	Age(year)	Weight(m/kg)	BMI(kg·m^－2)	ASA Classification (Ⅰ/Ⅱ)
Normal control	31	17/14	46.6±16.1	64.8±8.9	24.4±3.5	4/27
Esketamine
Low dose	33	18/15	49.5±16.7	67.1±10.2	25.0±3.4	4/29
High dose	33	15/18	48.1±16.5	66.1±7.5	25.5±3.6	5/28

Group	n	Surgery duration (t/min)	Anesthesia duration (t/min)	Extubation time (t/min)	PACU stay duration (t/min)
Normal control	31	92.76±14.68	101.25±15.80	10.12±1.62	56.50±6.25
Esketamine
Low dose	33	85.60±11.80	95.67±17.25	9.81±1.96	57.42±5.05
High dose	33	91.89±14.65	105.43±18.30	17.18±3.45^*△	56.63±5.85
F		2.567	2.664	91.69	0.246
P		0.080	0.080	<0.01	0.780
Group	n	Remifentanil usage (m/mg)	Sufentanil usage (m/μg)	Norepinephrine usage (m/mg)	Hydromorphone usage (m/mg)
Normal control	31	1.26±0.18	46.24±2.34	1.05±0.35	8.62±1.21
Esketamine
Low dose	33	1.35±0.24	42.17±2.97^*	0.53±0.28^*	6.21±1.10^*
High dose	33	1.27±0.14	43.45±2.01^*	0.48±0.22^*	5.93±1.05^*
F		2.162	4.425	38.33	55.18
P		0.120	0.020	<0.01	<0.01
^P<*0.05 vs normal control group;^△P<0.05 vs low dose of esketamine group.

Group	HR（beat·min^－1）
	T₀	T₁	T₂	T₃		T₀	T₁	T₂	T₃
Normal control	79.28±6.52	63.45±9.81^*	61.36±8.67^*	68.79±8.94	103.45±14.78		84.45±17.92^*	83.27±15.75^*	96.28±9.52
Esketamine Low dose	84.45±9.81	3.28±6.52^△	65.28±6.52	75.41±7.26	100.18±11.72		98.59±9.13^△	96.12±16.82	104.36±8.67
High dose	83.85±8.04	74.73±7.93^△	67.73±7.93	74.93±7.33	101.69±16.92		97.36±19.40^△	94.38±17.34	108.15±8.04
T₀ ：15 min before operation；T₁ ：20 min after induction administration；T₂：1 h during operation；T₃：30 min after extubation.^*P<0.05 compared with T₀； ^△P<0.05 compared with normal control group.

Group	n	Mechanical pain threshold non-dominant forearm
Group	n	1 d before operation	2 h after operation	6 h after operation	12 h after operation	24 h after operation	48 h after operation
Normal control	31	178.78±49.22	112.56±37.34	107.13±38.35^*	135.17±44.68	147.89±77.02	169.47±55.18
Esketamine
Low dose	33	167.91±37.34	179.24±47.76^△	138.79±48.27	27.28±43.34	157.52±60.78	159.08±43.33
High dose	33	171.32±73.34	199.16±58.98^*△	171.85±52.12	174.33±39.97	184.22±60.23	174.97±70.27
F		0.3189	27.110	15.320	11.450	2.611	0.652
P		0.73	<0.01	<0.01	<0.01	<0.01	<0.01
Group	n	Mechanical pain threshold around the surgical incision
Group	n	1 d before operation	2 h after operation	6 h after operation	12 h after operation	24 h after operation	48 h after operation
Normal control	31	170.81±61.57	109.06±39.31^*	89.93±47.42^*	102.18±54.99^*	117.89±48.24^*	123.57±46.88
Esketamine
Low dose	33	157.42±39.57	139.24±52.91^△	129.38±65.82^△	137.24±53.12^△	141.16±58.07	143.98±33.28
High dose	33	170.01±46.57	159.34±51.64^△	161.54±57.63^△	157.28±39.71^△	169.34±38.45^△	153.49±44.41
F		0.741	8.667	12.350	10.050	8.886	4.243
P		0.48	<0.01	<0.01	<0.01	<0.01	0.02

Group	n	NRS score
Group	n	2 h after operation	12 h after operation	24 h after operation	48 h after operation
Normal control	31	2.00（2.00,2.00）	1.00（0.00,1.00）	0.00（1.00,0.00）	0.00（0.00,0.00）
Esketamine
Low dose	33	2.00（1.00,2.00）	0.00（0.00,1.00）	0.00（0.00,0.00）	0.00（0.00,0.00）
High dose	33	2.00（0.0,2.000）	0.00（0.00,1.00）	0.00（0.00,0.00）	0.00（0.00,0.00）
P		0.58	1.00	1.00	1.00

Effects of different doses of esketamine on remifentanil-induced hyperalgesia in patients underwent thoracoscopic pulmonary lobectomy

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Group	n	Ramsay sedation score
Group	n	5 min after extubation	30 min after extubation
Normal control	31	2.00（1.00,2.00）	2.00（0.00,2.00）
Esketamine
Low dose	33	2.00（0.00,2.00）	2.00（0.00,2.00）
High dose	33	3.00（1.00,3.00）	2.00（0.00,2.00）

Group	n	Hallucinations and delirium	Nausea and vomiting	Increased glandular secretion	Pruritus	Blurred vision	High blood pressure
Normal control	31	4（12.90）	1（3.23）	2（6.46）	1（3.23）	2（6.46）	1（3.23）
Esketamine
Low dose	33	5（15.15）	1（3.03）	2（6.06）	2（6.06）	1（3.03）	3（9.09）
High dose	33	13（39.39^*△）	6（18.18）	8（24.24）	3（9.09）	1（3.03）	4（12.12）

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