Effect of conventional anesthesia combined with low dose esketamine on pain and stress response after laparoscopic total hysterectomy
10.3760/cma.j.cn115807-20240117-00022
- VernacularTitle:常规麻醉联合小剂量艾司氯胺酮对腹腔镜全子宫切除术后疼痛、应激反应影响
- Author:
Caishu LIU
1
;
Jing LIU
;
Weiwei FENG
;
Xiaoman WANG
;
Yuewen WANG
Author Information
1. 定州市人民医院麻醉科，定州 073000
- Keywords:
Esketamine;
Laparoscopy;
Total hysterectomy;
Pain;
Stress
- From:
Chinese Journal of Endocrine Surgery
2024;18(3):445-449
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of conventional anesthesia combined with low dose esketamine on pain and stress response in patients undergoing laparoscopic total hysterectomy.Methods:A total of 150 patients with laparoscopic total hysterectomy admitted to our hospital from Jan. 2022 to Dec. 2023 were selected as subjects. All patients were divided into control group and study group by coin toss method, with 75 cases in each group. The control group were given conventional anesthesia, and the study group were given a small dose of esketamine. Intraoperative sedation, hemodynamics at different times, postoperative pain, stress response and the incidence of adverse reactions were compared between the two groups.Results:There was no significant difference in hemodynamics between the two groups ( P>0.05). Mean arterial pressure (MAP) was (94.84±6.02), (86.14±5.99) mmHg, systolic blood pressure (SBP) was (96.48±5.72), (96.48±5.69) mmHg; Heart rate (HR) was 95.51±5.95, 84.05±5.57 times/min, while they were 102.05±6.13, 93.71±6.25, 105.03±6.07, 104.37±6.02 mmHg, 102.49±6.87, 90.51±5.86 times/min, respectively in the control group. The study group was significantly lower than the control group ( P<0.05). SpO2 at extubation and extravasation were (97.47±1.24) % and (98.11± 1.24) % in study group and (96.32±1.21) % and (97.03±1.23) % in the control group, significantly higher than those in the control group ( P<0.05). VAS scores at 3 h, 6 h, 12 h and 24 h were 1.71±0.35, 2.58±0.53, 3.27±0.68, 3.86±0.82 in the study group and 2.13±0.42, 3.74±0.75, 4.52±1.01, 4.53±1.04 in the control group. The study group was significantly lower than the control group ( P<0.05). Study group 5-hydroxytryptamine (5-HT), substance P (SP), norepinephrine, NE) levels were 29.53±7.68, 37.44±8.16, 49.71±9.56 ng/mL, and 52.81±10.04, 54.62±10.25, 61.23±10.08 ng/mL in the control group, significantly lower than those in the control group ( P<0.05). Postoperative 2 d study group calcitonin gene related peptide (calcitonin gene related peptide, CGRP), neuropeptide Y (NPY) and cortisol (Cor) levels were 158.41±27.06 pg/mL, 127.84±24.21 pg/mL and 240.37±31.55 nmol/L. The control group was 175.49±30.28 pg/mL, 153.92±28.63 pg/mL, 251.18±34.92 nmol/L, and the study group was significantly lower than the control group ( P<0.05). The incidence of adverse reactions in the study group was 10.67% (8/75), and the control group was 16.00% (12/75), with no statistical significance ( P>0.05) . Conclusion:Conventional anesthesia combined with low-dose esketamine can help reduce intraoperative hemodynamic changes in patients with laparoscopic total hysterectomy, improve sedation effect, relieve postoperative pain, reduce postoperative pain factors and oxidative stress related indexes of patients without increasing adverse reactions, and has good efficacy and safety.
