Combination of Ropivacaine Hydrochloride and Esketamine for Thoracic Paravertebral Block on Pain and Postoperative Recovery of Patients Undergoing Radical Resection Surgery for Lung Cancer.

Purpose: This study aims to investigate the efficacy of a combination of ropivacaine hydrochloride and esketamine in paravertebral block (PVB), in providing analgesia and promoting the postoperative recovery of patients undergoing elective thoracoscopic radical lung cancer surgery.

Design: A randomized controlled trial was conducted involving 70 patients scheduled for elective thoracoscopic radical lung cancer surgery.

Methods: Participants were randomly assigned to either the esketamine group (K group) or the control group (C group). Patients in the K group were administered a combination of 0.1 mg/kg of esketamine and 0.5% ropivacaine for PVB, while patients in the C group received only 0.5% ropivacaine. The time interval between the patient's discharge from the postanesthesia care unit and the first press of the analgesic pump and the number of presses. Various parameters that were monitored included the patients' mean arterial pressure, heart rate, and oxygen saturation at different time points; levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein in venous blood preoperatively and 6 hours postoperatively; pain assessed using the numeric rating scale scores.

Findings: Compared with group C, patients in group K had significantly longer intervals before their first postoperative analgesic pump press and significantly fewer effective analgesic pump presses in the 48-hour postoperative period. Resting numeric rating scale scores were significantly lower in group K at 24 and 48 hours postoperatively (both P < .05). In terms of postoperative recovery, sedation score during extubation was lower in group K compared with group C (P < .05). Patients in group K had significantly improved quality of recovery on the third day postoperatively (both P < .05). The levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein in venous blood were significantly lower in group K than in group C 24 hours postoperatively, and the difference was statistically significant (P < .05).

Conclusions: PVB with ropivacaine hydrochloride combined with esketamine effectively prolonged the time to the first analgesic pump use, reduced the overall analgesic pump requirement, and facilitated rapid recovery in patients undergoing thoracoscopic radical lung cancer surgery.