Comparison Between Low-Dose Esketamine and Dexmedetomidine on Postoperative Recovery Quality Among Patients Undergoing Humeral Trauma Surgery in Interscalene Brachial Plexus Block: A Randomized, Double-Blind, Controlled Trial.

Abstract

Purpose: Patients with humeral fracture often suffer from post-traumatic neuropsychiatric sequelae, which can cause immense anxiety or fear and worsen recovery. In this report, we examined the effect of low-dose esketamine versus dexmedetomidine on postsurgical recovery among patients who underwent humerus surgery with interscalene brachial plexus block.

Patients and methods: In this prospective, randomized, controlled study, 141 patients aged 18 to 65 years who underwent humerus reduction and internal fixation were recruited. Patients were randomly assigned to two groups: esketamine (Group E: received 0.2 mg/kg (i.v.) esketamine administration, with subsequent continuous 0.15mg/kg/h infusion); dexmedetomidine (Group D: received 10-min 0.8µg/kg dexmedetomidine infusion, with 0.4ug/kg/h maintenance infusion). All infusions were terminated at closure of surgical incisions. Our major endpoint was the Quality of Recovery-40 (QoR-40) score on postoperative day 1 (POD-1). The secondary outcomes were QoR-40 POD-3, the intraoperative modified observer's assessment of alert/Sedation (MOAA/S) scores at 5 min (T1) and 10 min (T2) post i.v. administration, at operation initiation (T3), at 10 min interval (T4), 30 min interval (T5) post operation, and at the end of operation (T6), Numeric Rating Scale (NRS) at POD-1, additional postoperative analgesic usage and hospital stays. In addition, we analyzed safety indices, such as hemodynamic profile, postoperative nausea and vomiting, adverse events (AEs) involving the central nervous system.

Results: The QoR-40 scores on POD-1 for Group E were substantially elevated relative to Group D. The T4 and T5 MOAA/S scores of Group D were lower relative to Group E. In comparison to Group E, Group D exhibited reduced T1 and T2 Mean arterial pressure (MAP) and T1-T6 Heart rate (HR). Lastly, we observed no marked alteration in other postsurgical AEs between the two patient cohorts.

Conclusion: Continuous low-dose esketamine infusion seems safely and tolerably, it significantly improves the postoperative recovery quality among patients with ASA I or II receiving elective humeral trauma surgery.