术中静脉注射艾司氯胺酮对踝关节骨折患者神经阻滞后反跳痛的影响-东南大学学报医学版

术中静脉注射艾司氯胺酮对踝关节骨折患者神经阻滞后反跳痛的影响

单位：1. 安徽医科大学附属六安医院药学部, 安徽六安 237000;
2. 安徽医科大学附属六安医院麻醉科, 安徽六安 237000

分类号：R683.42

出版年·卷·期（页码）：2025·44·第一期（85-90）

摘要：

目的:评价术中静脉注射艾司氯胺酮对踝关节骨折患者外周神经阻滞后反跳痛的影响。方法:选择2023年1月至12月在安徽医科大学附属六安医院择期全身麻醉下行踝关节骨折切开复位内固定术的60例患者,将患者随机均分为对照组和艾司氯胺酮组。艾司氯胺酮组患者麻醉诱导时静脉注射艾司氯胺酮0.5 mg·kg^-1,手术结束前30 min静脉注射艾司氯胺酮0.3 mg·kg^-1。对照组在麻醉诱导时及手术结束前30 min给予等量生理盐水。记录两组患者术后48 h的反跳痛发生率,术后6、12、24、48 h的静息NRS疼痛评分,拔管时间,术后麻醉恢复室(PACU)时间,术后48 h内不良反应,术后48 h经外周静脉穿刺中心静脉置管(PCIA)有效按压次数,舒芬总量,以及补救镇痛次数。结果:与对照组相比,艾司氯胺酮组患者术后 48 h内反跳痛的发生率明显降低(P<0.05);两组患者术后拔管时间与PACU 时间未见明显差异;两组患者术后6 h NRS疼痛评分无明显差异,而艾司氯胺酮组患者术后12、24、48 h NRS疼痛评分明显下降(P<0.05);艾司氯胺酮组患者术后48 h内PCIA有效按压次数、舒芬总量和补救镇痛次数明显少于对照组(P<0.05);两组患者术后48 h内不良反应无明显差异。结论:踝关节骨折切开复位内固定术患者分次小剂量静脉给予艾司氯胺酮可减轻术后NRS疼痛评分,降低收肌管联合坐骨神经阻滞后反跳痛发生率,减少阿片类药物消耗,且不增加术后不良反应。

Objective: To evaluate the effect of intraoperative intravenous esketamine on rebound pain after nerve block in patients with ankle fractures. Methods:A total of 60 patients undergoing open reduction and internal fixation of ankle fractures under elective general anesthesia in Lu'an Hospital Affiliated to Anhui Medical University from January 2023 to December 2023 were randomly divided into two groups:control group and esketamine group. The patients in the esketamine group were injected with 0.5 mg·kg^-1 of intravenous esketamine during anesthesia induction, and another intravenous injection of esketamine at 0.3 mg·kg^-1 30 minutes before the end of the operation. The control group was given the same amount of normal saline at the time of anesthesia induction and 30 minutes before the end of the operation. The incidence of rebound pain at 48 h after surgery was recorded, the pain scores of resting NRS at 6, 12, 24 and 48 h after surgery, the time of extubating and PACU stay and adverse reactions within 48 h after surgery were recorded, and the number of effective peripherally inserted central catheter(PCIA) compressions, the total amount of sufen and the number of salvage analgesia were recorded in the two groups. Results:Compared with the control group, the incidence of rebound pain within 48 h in the esketamine group was significantly lower(P<0.05). There were no significant differences between the two groups in the postoperative extubating time and the PACU stay. There was no significant difference in the pain score of the two groups at 6 h after surgery. Compared with the control group, the NRS pain score of the 12, 24 and 48 h in the esketamine group was significantly lower(P<0.05), and the effective number of PCIA compressions, the total amount of sufen and the number of rescue analgesia in the esketamine group within 48 h after surgery were significantly lower than those in the control group(P<0.05). There was no significant difference in adverse reactions between the two groups within 48 h after surgery. Conclusion:Fractional low-dose intravenous administration of esketamine to patients undergoing open reduction and internal fixation of ankle fractures can reduce postoperative pain scores, reduce the incidence of rebound pain after adductor canal combined with sciatic nerve block, reduce opioid consumption without increasing postoperative adverse effects.

参考文献：

[1] SORT R, BRORSON S, GOGENUR I, et al.Peripheral nerve block anaesthesia and postoperative pain in acute ankle fracture surgery:the AnAnkle randomised trial[J]. Br J Anaesth, 2021, 126(4):881-888.
[2] BARRY G S, BAILEY J G, SARDINHA J, et al.Factors associated with rebound pain after peripheral nerve block for ambulatory surgery[J]. Br J Anaesth, 2021, 126(4):862-871.
[3] LAVAND'HOMME P.Rebound pain after regional anesthesia in the ambulatory patient[J]. Curr Opin Anaesthesiol, 2018, 31(6):679-684.
[4] FANG J, SHI Y, DU F, et al.The effect of perineural dexamethasone on rebound pain after ropivacaine single-injection nerve block:a randomized controlled trial[J]. BMC Anesthesiol, 2021, 21(1):47.
[5] FEENEY A, PAPAKOSTAS G I.Pharmacotherapy:ketamine and esketamine[J]. Psychiatr Clin North Am, 2023, 46(2):277-290.
[6] HAN T, CHEN Q, HUANG J, et al.Low-dose esketamine with sufentanil for postcesarean analgesia in women with gestational diabetes mellitus:a prospective, randomized, double-blind study[J]. Front Endocrinol, 2023, 14:1202734.
[7] MOKINI Z, VITALE G, ALETTI G, et al.Pain control with ultrasound-guided inguinal field block compared with spinal anesthesia after hernia surgery:a randomized trial[J]. Surgery, 2015, 157(2):304-311.
[8] 单国法, 夏焱志, 郭明仁, 等."领结征"髂筋膜间隙阻滞联合闭孔神经阻滞在老年髋部骨折患者早期镇痛中的临床应用[J]. 现代医学, 2019, 47(7):812-815.
[9] SORT R, BRORSON S, GOGENUR I, et al.Rebound pain following peripheral nerve block anaesthesia in acute ankle fracture surgery:an exploratory pilot study[J]. Acta Anaesthesiol Scand, 2019, 63(3):396-402.
[10] KOPPERT W, SITTL R, SCHEUBER K, et al.Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans[J]. Anesthesiology, 2003, 99(1):152-159.
[11] ARGIRIADOU H, HIMMELSEHER S, PAPAGIANNOPOULOU P, et al.Improvement of pain treatment after major abdominal surgery by intravenous S+-ketamine[J]. Anesth Analg, 2004, 98(5):1413-1418.
[12] XU L L, WANG C, DENG C M, et al.Efficacy and safety of esketamine for supplemental analgesia during elective cesarean delivery:a randomized clinical trial[J]. JAMA Network Open, 2023 6(4):e239321.
[13] ZHANG Y, CUI F, MA J H, et al.Mini-dose esketamine-dexmedetomidine combination to supplement analgesia for patients after scoliosis correction surgery:a double-blind randomised trial[J]. Br J Anaesth, 2023, 131(2):385-396.
[14] ZHU Y, LI Q, LIU G, et al.Effects of esketamine on postoperative rebound pain in patients undergoing unilateral total knee arthroplasty:a single-center, randomized, double-blind, placebo-controlled trial protocol[J]. Front Neurol, 2023, 14:1179673.
[15] MASSOTH C, SCHWELLENBACH J, SAADAT-GILANI K, et al.Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy-a randomised controlled trial[J]. J Clin Anesth, 2021, 75:110437.
[16] WANG X, LIN C, LAN L, et al.Perioperative intravenous S-ketamine for acute postoperative pain in adults:a systematic review and meta-analysis[J]. J Clin Anesth, 2021, 68:110071.

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