通讯作者: 代红雨, daihy0326@163.com

DOI：10.12201/bmr.202607.00018

Effectiveness of Perioperative S-ketamine on Postoperative Pain in Patients with Osteoarthritis Undergoing Total Knee Arthroplasty

• 摘要：目的 观察围术期S-氯胺酮干预对全膝关节置换(total knee arthroplasty,TKA)患者术后疼痛的影响,并探索术前中枢敏化、焦虑、抑郁及疼痛等风险因素对其干预效果的调节效应。方法 选取2024年12月至2026年3月拟行单侧TKA的膝骨关节炎患者124例,年龄60~75岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级 Ⅰ~Ⅱ级,体重指数(body mass index,BMI)18~30 kg/m2,随机分为对照组(n=61)和S-氯胺酮组(n=63)。S-氯胺酮组于麻醉诱导后经静脉给予负荷剂量S-氯胺0.3 mg/kg,术毕通过患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)以0.015 mg/kg*h的剂量持续输注至术后48 h；对照组给予等容积生理盐水。采用视觉模拟评分法(visual analogue scale, VAS)评价疼痛强度。主要观察指标为术后48 h内中重度疼痛的发生率；次要观察指标包括术后各时间段疼痛评分、术后48 h内补充镇痛率、药物相关不良反应及恢复质量。通过亚组分析评估术前风险因素与S-氯胺酮疗效的交互作用。结果SS-氯胺酮组术后48h内中重度疼痛发生率(15.87%比36.07%,校正OR=0.194,95%CI：0.060~0.629,校正P=0.006)及补充镇痛率均显著低于对照组。S-氯胺酮组术后12~24h VAS评分低于对照组,但降幅未达最小临床重要性差异阈值；术后恢复质量评分高于对照组。S-氯胺酮组苏醒延迟发生率更高。亚组分析显示,术前中枢敏化显著调节S-氯胺酮的疗效(交互作用P=0.026)；在术前存在中枢敏化的患者中,S-氯胺酮组中重度疼痛发生率显著低于对照组(6.9%比50.0%,OR=0.074,P=0.003)。结论S围术期S-氯胺酮可降低TKA术后中重度疼痛发生率及补充镇痛需求,改善术后恢复质量,但伴有苏醒延迟风险,且对疼痛评分的改善缺乏临床显著性。亚组分析提示,基于术前中枢敏化状态的分层干预或是优化TKA围术期疼痛管理的有效措施。

  关键词： 全膝关节置换术; S-氯胺酮; 疼痛; 中枢敏化

   

  Abstract: Objective To investigate the effect of perioperative S-ketamine intervention on postoperative pain in patients undergoing total knee arthroplasty (TKA) and to explore the moderating effects of preoperative central sensitization, anxiety, depression, and pain-related risk factors on the intervention efficacy. MethodsSA total of 124 patients with knee osteoarthritis scheduled for unilateral TKA between December 2024 and March 2026 were enrolled. Patients aged 60–75 years, with American Society of Anesthesiologists (ASA) grade Ⅰ–Ⅱ, body mass index (BMI) 18–30 kg/m2, were randomly divided into a control group (n=61) and an S-ketamine group (n=63). The S-ketamine group received an intravenous loading dose of S-ketamine 0.3 mg/kg after anesthesia induction, followed by continuous infusion via patient-controlled intravenous analgesia (PCIA) at a rate of 0.015 mg/kg.h until 48 h postoperatively. The control group received an equal volume of normal saline. Pain intensity was assessed using the Visual Analogue Scale (VAS). The primary outcome was the incidence of moderate-to-severe pain within 48 h postoperatively. Secondary outcomes included pain scores at various postoperative time points, rate of rescue analgesia within 48 h postoperatively, medication-related adverse reactions, and quality of recovery. Subgroup analyses were performed to evaluate the interaction between preoperative risk factors and the efficacy of S-ketamine. ResultsSThe incidence of moderate-to-severe pain within 48 h postoperatively (15.87% vs. 36.07%, adjusted OR = 0.194, 95% CI: 0.060–0.629, adjusted P = 0.006) and the rate of rescue analgesia were significantly lower in the S-ketamine group than in the control group. The VAS scores in the S-ketamine group were lower than those in the control group at 12–24 h postoperatively, but the reduction did not reach the minimum clinically important difference threshold. The quality of recovery score was higher in the S-ketamine group than in the control group. The incidence of delayed emergence was higher in the S-ketamine group. Subgroup analysis revealed that preoperative central sensitization significantly moderated the efficacy of S-ketamine (P for interaction = 0.026). Among patients with preoperative central sensitization, the incidence of moderate-to-severe pain was significantly lower in the S-ketamine group than in the control group (6.9% vs. 50.0%, OR = 0.074, P = 0.003). ConclusionSPerioperative S-ketamine reduces the incidence of moderate-to-severe pain and the need for rescue analgesia following TKA, and improves postoperative quality of recovery; however, it is associated with a risk of delayed emergence and lacks clinically significant improvement in pain scores. Subgroup analysis suggests that stratified intervention based on preoperative central sensitization status may be an effective strategy to optimize perioperative pain management in TKA.

  Key words: STotal; knee arthroplasty, S-ketamine, Pain, Central; sensitization; 

  提交时间：2026-07-08

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• 序号	提交日期	编号	操作
  1	2026-06-07	10.12201/bmr.202607.00018V1	下载

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