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已发表论文
静脉注射艾司氯胺酮对肩关节镜手术患者单次臂丛神经阻滞术后反弹痛的影响：一项前瞻性、随机、安慰剂对照研究
Authors Chen J, Pan Z, Zheng J
Received 11 April 2025
Accepted for publication 29 September 2025
Published 7 October 2025 Volume 2025:18 Pages 5235—5248
DOI https://doi.org/10.2147/JPR.S533774
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Karina Gritsenko
Jiale Chen,1 Zhihao Pan,1 Jinwei Zheng2
1Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China; 2Department of Anesthesiology, Ningbo NO.2 Hospital, Ningbo, People’s Republic of China
Correspondence: Jinwei Zheng, Department of Anesthesiology, Ningbo NO.2 Hospital, Ningbo, People’s Republic of China, Tel +86 13777112140, Email zjw_1007@163.com
Purpose: Rebound pain (RP) often occurs after the resolution of peripheral nerve blocks. Studies suggest that perineural esketamine prolongs block duration and reduces RP incidence. This study aimed to determine whether intravenous esketamine reduces RP incidence following single-shot interscalene brachial plexus block (ISBPB) in shoulder arthroscopic surgery.
Patients and methods: In this randomized controlled trial, 200 patients scheduled for shoulder arthroscopy received ultrasound-guided single-shot ISBPB preoperatively and were randomized to receive either intravenous esketamine (0.5 mg/kg bolus + 0.25 mg/kg/h infusion) or placebo. Primary outcomes included RP incidence, onset time, duration, and pain scores. Secondary outcomes included block duration, postoperative pain scores, and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]).
Results: The incidence rates of rebound pain (RP) were comparable between groups, with no significant differences in RP duration or pain scores (P> 0.05). However, the Numeric Rating Scale at rest (NRS-R) scores at 8h, 12h, and 24h postoperatively were significantly higher in the C-group compared to the E-group (P< 0.05). Hemodynamic stability was superior in the E-group during immediately post-administration (T4) to skin incision (T8), with higher MAP at T6–T10 (P< 0.05). Sensory/motor block onset and duration showed no intergroup differences (P> 0.05). Adverse events (dizziness, nausea) were comparable, with one transient hallucination in the E-group.
Conclusion: Patients undergoing arthroscopic rotator cuff repair under combined single-shot interscalene brachial plexus block and general anesthesia exhibit a rebound pain incidence of approximately 25%. Intravenous administration of esketamine (0.5 mg/kg bolus followed by continuous infusion at 0.25 mg/kg/h) during the operation failed to significantly reduce the incidence of rebound pain post-block (P> 0.05). However, it demonstrated significant reductions in pain scores at 8h, 12h, and 24h postoperatively (P< 0.05), with enhanced hemodynamic stability observed from anesthetic induction to pre-incision periods. No severe adverse events were reported.
Keywords: esketamine, rebound pain, interscalene brachial plexus block, rotator cuff tear
1Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China; 2Department of Anesthesiology, Ningbo NO.2 Hospital, Ningbo, People’s Republic of China
Correspondence: Jinwei Zheng, Department of Anesthesiology, Ningbo NO.2 Hospital, Ningbo, People’s Republic of China, Tel +86 13777112140, Email zjw_1007@163.com
Purpose: Rebound pain (RP) often occurs after the resolution of peripheral nerve blocks. Studies suggest that perineural esketamine prolongs block duration and reduces RP incidence. This study aimed to determine whether intravenous esketamine reduces RP incidence following single-shot interscalene brachial plexus block (ISBPB) in shoulder arthroscopic surgery.
Patients and methods: In this randomized controlled trial, 200 patients scheduled for shoulder arthroscopy received ultrasound-guided single-shot ISBPB preoperatively and were randomized to receive either intravenous esketamine (0.5 mg/kg bolus + 0.25 mg/kg/h infusion) or placebo. Primary outcomes included RP incidence, onset time, duration, and pain scores. Secondary outcomes included block duration, postoperative pain scores, and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]).
Results: The incidence rates of rebound pain (RP) were comparable between groups, with no significant differences in RP duration or pain scores (P> 0.05). However, the Numeric Rating Scale at rest (NRS-R) scores at 8h, 12h, and 24h postoperatively were significantly higher in the C-group compared to the E-group (P< 0.05). Hemodynamic stability was superior in the E-group during immediately post-administration (T4) to skin incision (T8), with higher MAP at T6–T10 (P< 0.05). Sensory/motor block onset and duration showed no intergroup differences (P> 0.05). Adverse events (dizziness, nausea) were comparable, with one transient hallucination in the E-group.
Conclusion: Patients undergoing arthroscopic rotator cuff repair under combined single-shot interscalene brachial plexus block and general anesthesia exhibit a rebound pain incidence of approximately 25%. Intravenous administration of esketamine (0.5 mg/kg bolus followed by continuous infusion at 0.25 mg/kg/h) during the operation failed to significantly reduce the incidence of rebound pain post-block (P> 0.05). However, it demonstrated significant reductions in pain scores at 8h, 12h, and 24h postoperatively (P< 0.05), with enhanced hemodynamic stability observed from anesthetic induction to pre-incision periods. No severe adverse events were reported.
Keywords: esketamine, rebound pain, interscalene brachial plexus block, rotator cuff tear