Opioid-Free Anesthesia with Esketamine Combined with Iliac Fascia Block in Elderly Patients Undergoing Hip Surgery

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Background: Most patients with hip fractures are elderly people with relatively high risks of cardiovascular and cerebrovascular accidents. Esketamine has little effect on haemodynamics and has an exact analgesic effect, which is beneficial for patients with intolerance to surgery and anaesthesia. Therefore, we conducted this study to compare the efficacy and safety of esketamine with those of opioids in elderly patients who underwent surgery for hip fractures. Methods: Seventy-two patients were included in the study, but data from only 68 were analysed. Patients were randomly assigned to either the EKT group (esketamine combined with iliac fascia block) or the OP group (opioids combined with iliac fascia block). Esketamine was used for anaesthesia induction and maintenance in the EKT group, and sufentanil and remifentanil were used in the OP group. The primary endpoint was the area under the curve numeric rating scale (AUC NRS ). Results: The AUC NRS in the EKT group was significantly lower than that in the OP group (6.6± 3.6 vs 9.5± 3.0, P =0.001). The postoperative numeric rating scale (NRS) scores for pain and the number of rescue analgesia were significantly lower in the EKT group than in the OP group (all P < 0.05). The mean blood pressure in the EKT group was significantly greater than those in the OP group after anaesthesia induction (all P < 0.05). The incidence of postoperative nausea and vomiting (PONV) in the OP group was significantly higher than that in the EKT group ( P =0.033). Conclusion: Elderly patients receiving esketamine-based opioid-free anaesthesia had more stable hemodynamics, better postoperative analgesia, and reduced PONV incidence compared to those undergoing opioid-balanced anaesthesia. Clinical Trial Registration: The trial was registered at the Chinese Clinical Trial Registry on September 1, 2023 (identifier: ChiCTR2300075324). Keywords: opioid-free anaesthesia, esketamine, hip fractures, elderly individuals, postoperative analgesia

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