The use of Esketamine in CT-guided percutaneous liver tumor ablation reduces the consumption of remifentanil: a randomized, controlled, double-blind trial

Abstract

Background: In the anesthesia management of percutaneous liver tumor ablation, the requirement of analgesia is very strict. Currently, intravenous anesthesia is commonly used, such as remifentanil combined with sedative drugs. However, the pain relief is not instantaneous after increasing the dosage of remifentanil.Esketamine, a medium-or long-term analgesic drug, does not inhibit respiration to maintain patient comfort during the ablation and reduces the consumption of remifentanil. Therefore, this experiment was designed to investigate the potential of combinational therapy and the most appropriate dose of esketamine.Methods: A total of 120 patients were randomly divided into three groups by SPSS. The regular anesthesia model included dexmedetomidine 0.5 μg/kg, intravenous glucose tolerance test, remifentanil continuous infusion, flurbiprofen 50 mg, i.v., palonosetron 0.225 mg, i.v., and 1% lidocaine for local anesthesia. Group A was the regular control group, only using the regular model; Group B also received with 0.1 mg/kg esketamine, i.v.; and Group C also received 0.2 mg/kg esketamine, i.v.. The whole experiment was doubleblind.

Effects of the Different Doses of Esketamine on Postoperative Quality of Recovery in Patients Undergoing Modified Radical Mastectomy: A Randomized, Double-Blind, Controlled Trial

“… 25 Su et al found that esketamine administration significantly decreased the dosage of remifentanil and reduced the incidence of severe pain with liver tumor ablation. 26 However, Brinck et al revealed that intraoperative S(+)-ketamine administration did not alleviate postoperative pain and oxycodone consumption undergoing major lumbar fusion surgery. 27 In the present study, our results indicated that low-dose esketamine infusion relieved NRS pain scores during the first postoperative 6 h period and high-dose esketamine alleviated NRS pain scores during the first postoperative 24 h period.…”

Effects of the Different Doses of Esketamine on Postoperative Quality of Recovery in Patients Undergoing Modified Radical Mastectomy: A Randomized, Double-Blind, Controlled Trial [Letter]

“…The available evidence indicates that the use of esketamine can reduce the dosages of remifentanil and propofol required for the maintenance of anesthesia. 2,3 Third, this study used a single-mode postoperative analgesia strategy in all patients, ie, non-steroidal antiinflammatory drugs were administered if the postoperative numeric rating scale pain score was more than 3. In fact, the current Enhanced Recovery After Surgery protocols recommend a multimodal strategy for postoperative analgesia, in which nerve or fascial plane block and a package of basic analgesics, such as paracetamol, non-steroidal antiinflammatory drugs or cyclooxygenase-2 specific inhibitors, and dexamethasone, is included.…”

Thrifty effect of subanesthetic‐dose S‐ketamine on postoperative opioids and its safety and analgesic effectiveness: A prospective, triple‐blind, randomized controlled, polycentric clinical trial

“…It has a stronger affinity for NMDA receptors but fewer side effects than ketamine, providing a more comfortable experience for patients 11 . Some clinical data have shown that S‐ketamine as a general anesthetic can be used safely and effectively in general anesthesia for many types of surgery at a dose of 0.5 mg/kg in clinical practice 12 . For pediatric surgery for lower limb fracture, S‐ketamine at dose of 0.5 mg/kg combined with the nerve block has a perfect analgesic effect, fast anesthetic effect, and low incidence of pediatric agitation 13 .…”

“… 11 Some clinical data have shown that S‐ketamine as a general anesthetic can be used safely and effectively in general anesthesia for many types of surgery at a dose of 0.5 mg/kg in clinical practice. 12 For pediatric surgery for lower limb fracture, S‐ketamine at dose of 0.5 mg/kg combined with the nerve block has a perfect analgesic effect, fast anesthetic effect, and low incidence of pediatric agitation. 13 This suggests that S‐ketamine does have a distinct advantage in the induction of general anesthesia.…”