Safety and efficacy of esketamine for postoperative analgesia in pediatric patients with hypospadias

Abstract

ObjectiveTo explore the safety and efficacy of the combination of continuous intravenous infusion of esketamine with sacral block for postoperative analgesia in pediatric patients undergoing surgery for hypospadiasMethodsPediatric patients (n = 77) undergoing surgery for hypospadias were randomized into two groups: a hydromorphone group (H group, initial dose, 0.02 mg/kg; maintenance dose, 0.01 mg/kg/h) or an esketamine group (E group, initial dose, 0.3 mg/kg; maintenance dose 0.15 mg/kg/h). Caudal epidural block involved injection of 0.2% ropivacaine 1 ml/kg through the sacral hiatus. Age, weight, grade of hypospadias, intraoperative blood loss, operative time, and awaking time of patients were recorded. The Face, Legs, Activity, Cry and Consolability (FLACC) scale and Ramsay sedation scores were recorded when leaving the PACU (0 h) and at postoperative 2, 6, 12, 24, 36, and 48 h. The Pediatric Anesthesia Emergence Delirium Scale (PAED), incidence of hypotension, respiratory depression, nausea and vomiting and pruritus, and the time to first bowel movement after surgery were recorded.ResultsThere were no significant differences in demographic and clinical characteristics between the H group and the E group. There were no significant differences in FLACC scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in intra-group and inter-group comparisons. There were no significant differences in Ramsay sedation scores at postoperative 0, 2, 6, 12, 24, 36, and 48 h in the intra-group comparisons. Ramsay sedation scores were significantly lower at postoperative 2, 12, and 36 h in the H group compared to the E group. There were no significant differences in the PAED scale or incidence of nausea and vomiting or pruritus between the H group and the E group. The incidence of hypotension and respiratory depression was significantly lower, and the time to first bowel movement was significantly shorter in the E group compared to the H group. Urinary tryptophan, 5-hydroxytryptamine and substance P levels were significantly lower but arginine was significantly higher in the E group compared to the H group.ConclusionsThe combination of continuous intravenous infusion of esketamine with sacral block provided safe and effective postoperative analgesia for pediatric patients undergoing surgery for hypospadias.Trial registrationChinese Clinical Trial Register ChiCTR2200066967. Clinical trial registry URL: http://www.chictr.org.cn/edit.aspx?pid=185042&htm=4

Efficacy and safety of esketamine for pediatric gastrointestinal endoscopy: a meta-analysis and trial sequential analysis

“…Furthermore, esketamine has also been reported to significantly reduce the incidence of emergent agitation and inflammation levels after tonsillectomy ( Li et al, 2022 ; Liu et al, 2023 ). Another study involving 77 children undergoing hypospadias surgery demonstrated that, compared with hydromorphone combined with sacral block, esketamine combined with sacral block significantly reduced the incidence of hypotension and respiratory depression as well as shortened the time to first bowel movement ( Xu et al, 2023 ). Additionally, Zhang et al, (2023b) conducted a meta-analysis of 19 clinical trials and pointed out that, compared with the placebo or blank, the esketamine significantly shortened the postoperative recovery time, reduced pain and complication rates, and improved quality of life in pediatric patients.…”

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

“…Ying Zhang et al found the application of esketamine-dexmedetomidine in an analgesic pump in patients undergoing scoliosis correction significantly reduced the incidence of moderate to severe pain within 72 h and the incidence of moderate-to-severe postoperative pain was reduced by 24% [ 21 ]. Esketamine alone in analgesia pumps has also been shown to provide effective postoperative pain relief [ 22 , 23 ].…”