Analgesic Efficacy of Different Doses of Esketamine as an Adjuvant to Ropivacaine for Thoracoscopy-Guided Thoracic Paravertebral Block After Thoracoscopic Radical Resection for Lung Cancer: A Prospective Randomized Controlled Trial.

PURPOSE: Thoracoscopy-guided thoracic paravertebral block (TG-TPVB) is a new analgesia technique; however, the duration of a single TG-TPVB is short. Esketamine combined with local anesthetics can prolong the duration of nerve block. This study compared the analgesic efficacy of three doses of esketamine combined with ropivacaine for TG-TPVB in patients undergoing thoracoscopic radical resection for lung cancer.

METHODS

160 patients were randomly allocated into the control, S1, S2, and S3 groups. All patients received TG-TPVB with 20 mL of study solution. The control group received 0.375% ropivacaine alone, whereas the S1, S2, and S3 groups received 0.375% ropivacaine combined with esketamine at doses of 0.1, 0.2, and 0.3 mg/kg, respectively. The time to first patient-controlled intravenous analgesia (PCIA) demand, postoperative numerical rating scale (NRS) pain scores, sufentanil consumption, effective PCIA demands, recovery outcomes, and adverse events were compared between the four groups.

RESULTS

The time to first PCIA demand in the three esketamine groups were longer than in the control group. However, S2 and S3 groups were longer than S1 group. NRS pain scores in the three esketamine groups were lower than in the control group at 6, 12, 24, and 48 h postoperatively. Postoperative sufentanil consumption within 24 h, the number of effective PCIA demands and rescue analgesia administrations within 48 h were lower in the three esketamine groups than in the control group. Wake-up time was longer in the S3 group than in the control, S1, and S2 groups. The times to first ambulation and chest tube removal were shorter in the esketamine groups than in the control group (All P<0.001).

CONCLUSION

Esketamine combined with ropivacaine for TG-TPVB prolonged postoperative analgesia, reduce pain scores, reduced analgesic consumption, and facilitated recovery. Esketamine at 0.2 mg/kg seems to show a good balance effect in many aspects.