Effects of Esketamine Combined With Pericapsular Nerve Group Block on Quality of Recovery, Analgesic Outcomes, and Hemodynamics in Elderly Patients Undergoing Total Hip Arthroplasty.

Abstract

<h4>Purpose</h4>The study aimed to evaluate the association of esketamine combined with pericapsular nerve group (PENG) block with postoperative quality of recovery, analgesic outcomes, and perioperative hemodynamic profile in elderly patients undergoing total hip arthroplasty (THA).<h4>Design</h4>This is a single-center retrospective cohort study.<h4>Methods</h4>A retrospective analysis was conducted on 115 elderly patients who underwent unilateral THA under general anesthesia. Patients were classified into a control group (n = 60), which received PENG block alone, and a study group (n = 55), which received PENG block followed by a single slow intravenous injection of esketamine at 0.3 mg/kg. Outcome measures included postoperative quality of recovery assessed using the Quality of Recovery-15 (QoR-15) score, visual analog scale (VAS) pain scores, cumulative patient-controlled intravenous analgesia (PCIA) sufentanil consumption, perioperative hemodynamic parameters, and the incidence of adverse events.<h4>Findings</h4>At 24 hours and 72 hours after surgery, the study group had significantly higher QoR-15 scores and lower VAS pain scores than the control group (all P < .05). Additionally, the cumulative sufentanil consumption at 24 hours and 48 hours after surgery was significantly lower in the study group than in the control group (P < .05). Repeated-measures analysis of variance showed significant time effects for heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) (P < .001), significant group effects for HR, SBP, MAP and SpO₂ (P < .05), and significant time-by-group interaction effects for all analyzed hemodynamic parameters (P < .05). The proportion of patients experiencing at least one adverse event was significantly lower in the study group than in the control group (P = .040).<h4>Conclusions</h4>In elderly patients undergoing THA, esketamine combined with PENG block was associated with improved postoperative quality of recovery, better analgesic outcomes, reduced sufentanil consumption, and a lower incidence of postoperative adverse events. The combined regimen also showed a more favorable perioperative hemodynamic profile. These findings suggest that esketamine may be a useful adjunct to PENG block as part of multimodal analgesia for elderly patients undergoing THA.

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