Effects of Esketamine on Haemodynamics and Inflammatory Stress Response in Elderly Patients Undergoing Proximal Femoral Surgery.

Abstract

Objective: To determine the effects of esketamine combined with iliac fascia block on haemodynamics and inflammatory stress response in elderly patients undergoing proximal femoral nail anti-rotation (PFNA) surgery.

Study design: A single-centre randomised controlled trial. Place and Duration of the Study: Deparment of Anaesthesiology, the 904th Hospital of the Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, China, from January to December 2023.

Methodology: Eighty elderly patients undergoing PFNA surgery in the authors' hospital were selected as the research objects, regardless of gender, aged >65 years, with a body mass index (BMI) of 18-28 kg/m2, and the American Society of Anaesthesiologists (ASA) scores of II-III. Eighty elderly patients were randomly divided into the following two groups: The observation group (esketamine combined iliac fascia block) and the control group (remifentanil combined iliac fascia block). Heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at entry (T0), incision (T1), 15 minutes after incision (T2), and at the completion of surgery (T3). Before and 24 hours after surgery, interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Recovery quality was recorded 24 hours after surgery. The patients' anaesthesia-effect on adverse reactions were recorded during and after surgery.

Results: There was a significant difference between the two groups in the following indices: HR, MAP, and SpO2 at T1 (p <0.05). The values of IL-6 and CRP in the control group were prominently higher than those in the observation group 24 hours after surgery (p <0.05). The quality of recovery-15 (QoR-15) score of the control group was prominently lower than that of the observation group. The total incidence of adverse reactions of the control group was prominently higher than that of the observation group (p <0.05).

Conclusion: Implementing an anaesthesia regimen of esketamine combined with iliac fascia block for elderly patients undergoing PFNA surgery can help maintain haemodynamic stability and suppress the inflammatory stress responses.

Key words: Esketamine, Iliac fascia block, Internal fixation with anti-rotation intramedullary nails in the proximal femur, Haemodynamics, Inflammatory stress response.