Effectiveness of intraoperative S-ketamine infusion in alleviating postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures
10.3760/cma.j.cn501098-20240214-00150
- VernacularTitle:术中泵注S-氯胺酮对创伤性四肢长骨骨折切开复位内固定患者术后睡眠障碍的改善作用
- Author:
Xiang LI
1
;
Qiaomei ZHOU
;
Bo XU
Author Information
1. 中国人民解放军南部战区总医院麻醉科，广州 510010
- Keywords:
Wounds and injuries;
Fractures;
Sleep disorders;
Ketamine;
Anesthesia
- From:
Chinese Journal of Trauma
2024;40(7):628-634
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effectivensess of intraoperative S-ketamine infusion in alleviating postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures.Methods:A prospective randomized controlled study was conducted to analyze the clinical data of 84 patients with traumatic long bone fracture admitted to General Hospital of Southern Theatre Command of PLA from October 2022 to April 2023. The patients undergone selective open reduction and internal fixation were divided into S-ketamine group and saline group according to the random number table. Pittsburgh sleep quality index (PSQI) scores and hospital anxiety and depression scale (HADS) scores were compared between the two groups before surgery, at 24, 48, and 72 hours after surgery. Visual analogue scale (VAS) scores were compared between the two groups before, at 3, 6, 12, 24, 48, and 72 hours after surgery. The number of times the patients pressed the pump of patient-controlled intravenous analgesia postoperatively and adverse reactions such as nausea, vomiting, hallucinations or nightmares were recorded.Results:A total of 60 male and 24 female patients with traumatic long bone fracture were included, aged 18-65 years [36.5(25.5, 54.8)years]. The S-ketamine group ( n=42) received intravenous infusion of S-ketamine at a rate of 0.5 mg·kg -1·h -1 until the end of surgery, while the saline group ( n=42) received intravenous infusion of saline of the same volume until the end of surgery. All the patients were followed up for 4-9 days [6.0(5.0, 7.0)days]. No significant differences in PSQI scores were found between the two groups before surgery ( P>0.05), while PSQI scores at 24, 48, and 72 hours after surgery were 7.5(7.0, 9.0)points, 4.0(3.0, 5.3)points, and 1.0(1.0, 2.0)points respectively in the S-ketamine group, significantly lower than those in the saline group [10.0(8.0, 12.0)points, 7.0(5.0, 8.0)points, and 2.0 (1.0, 3.0)points] ( P<0.05 or 0.01). There were no significant differences in HADS scores between the two groups before surgery and at 48 and 72 hours after surgery ( P>0.05), while HADS score at 24 hours after surgery in the S-ketamine group was 2.0(0.0, 3.0)points, significantly lower than that in the saline group [3.0(2.0, 5.0)points] ( P<0.01). There were no significant differences in VAS scores between the two groups before, at 6, 12, and 72 hours after surgery ( P>0.05), while the VAS scores at 3, 24, and 48 hours after surgery in the S-ketamine group were 3.0(2.0, 4.0)points, 2.3(2.0, 3.0)points, and 2.0(1.0, 3.0)points respectively, significantly lower than those in the saline group [4.0(2.8, 5.0)points, 3.0(2.5, 4.0)points, and 3.0(2.0, 3.7)points] ( P<0.05). There were no significant differences in the number of times the patients pressed the pump of patient-controlled intravenous analgesia postoperatively and the incidence of nausea and vomiting between the two groups ( P>0.05). In the S-ketamine group, transient hallucination upon awakening was found in 2 patients and intraoperative nightmare in 1, who showed no abnormalities after returning to the ward. Conclusion:Intraoperative S-ketamine infusion can significantly alleviate postoperative sleep disorders of patients during open reduction and internal fixation for traumatic long bone fractures, with simultaneous alleviation of anxiety, depression as well as pain.
