Effects of different doses of esketamine combined with ropivacaine on rebound pain after arthro-scopic shoulder surgery under superior trunk brachial plexus block
- VernacularTitle:不同剂量艾司氯胺酮复合罗哌卡因臂丛上干阻滞对肩关节镜术后反弹性疼痛的影响
- Author:
Biao ZENG
1
;
Quanyang LIN
Author Information
- Keywords: Esketamine; Ropivacaine; Superior trunk brachial plexus block; Rebound pain; Shoulder arthroscopy
- From: The Journal of Clinical Anesthesiology 2024;40(9):922-927
- CountryChina
- Language:Chinese
- Abstract: Objective To investigate the effects of different doses of esketamine combined with ropivacaine on rebound pain after arthroscopic shoulder surgery under superior trunk brachial plexus block.Methods Ninety patients,including 35 males and 55 females,aged 18-60 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected for shoulder arthroscopy.According to the method of random number table,the patients were divided into three groups:group El,group E2 and group R,30 pa-tients in each group.Three groups of patients with nerve block local anesthetic drugs were allocated accord-ing to the following scheme.In group El,0.2％ropivacaine,esketamine 0.25 mg/kg,and normal saline total 10 ml.In group E2,0.2％ropivacaine,esketamine 0.5 mg/kg,and normal saline total 10 ml.In group R,0.2％ropivacaine and normal saline total 10 ml.General anesthesia was implemented for all pa-tients after the nerve block anesthesia.HR,MAP,and surgical pleth index(SPI)were recorded before nerve block(T1),30 minutes after nerve block(T2),laryngeal mask placement(T3),and 30 minutes during surgery(T4).The NRS scores and the occurrence of rebound pain were recorded at rest and exercise 6,8,12,24,and 48 hours after surgery.The onset time and duration of sensory and motor block after an-esthesia,sedation score before and after anesthesia,sleep quality within 24 hours after surgery,and the oc-currence of adverse reactions within 48 hours after surgery were recorded.Results There were no significant differences in HR and MAP among the three groups at different time points.Compared with group R,the dosage of sufentanil in groups E1 and E2 were significantly reduced,and the NRS score at rest and exercise 12 to 48 hours after surgery were significantly decreased(P＜0.05).Compared with group R,the incidence of rebound pain in group E2 was significantly reduced,and the score of sedation after nerve block was significantly increased,the sleep time was significantly prolonged,and the sleep efficiency was signifi-cantly increased within 1 day after surgery(P＜0.05).Compared with group R,the incidence of postoper-ative adverse reactions such as nausea,vomiting,dizziness and headache in groups El and E2 within 48 hours after surgery were significantly reduced(P＜0.05).There were no significant differences in the onset and duration of sensory block among the three groups,and no motor nerve block occurred.Conclusion Es-ketamine 0.5 mg/kg combined with ropivacaine can reduce the incidence of rebound pain after shoulder ar-throscopy with brachial plexus block,improve postoperative sleep quality,but cannot shorten the onset time of sensory block and increase the duration of block.
