Appropriate Combination of Nalbuphine Combined With Esketamine for Weakly Opioid Anesthesia in Postlaparoscopic...

Laparoscopic cholecystectomy (LC) often leads to abdominal wall incision pain, visceral pain, and shoulder and neck pain after surgery. Nalbuphine provides strong sedative and analgesic effects with minimal risk of adverse reactions. Esketamine, with its higher receptor affinity, significantly alleviates both visceral and somatic pain.

Our objective was to establish the optimal dosage of nalbuphine with esketamine for patient-controlled intravenous analgesia (PCIA) following LC, enhancing postoperative pain management for these patients.

This research employs a single-blind, randomized controlled trial methodology. Surgical patients were randomly assigned to three groups based on postoperative PCIA drug combinations: Group N received nalbuphine 2 mg·kg^-1 with 100 mL of 0.9% sodium chloride solution; Group NE₁ received esketamine 0.5 mg·kg^-1, nalbuphine 2 mg·kg^-1, and 100 mL of 0.9% sodium chloride solution; Group NE₂ received esketamine 1 mg·kg^-1, nalbuphine 2 mg·kg^-1, and 100 mL of 0.9% sodium chloride solution. The study observed VAS scores at rest and during activity, Ramsay sedation scores, and MoCA scores at 6, 12, 24, and 48 h postsurgery, along with the total and effective PCIA pressing times across the three groups. Adverse reactions and the frequency of rescue analgesia within 48 h postsurgery were monitored.

Compared to the N group, VAS scores and resting pain scores were substantially lower in the NE₁ and NE₂ groups at 6 h, 12 h, and 24 h postsurgery (p < 0.05). Compared to Group N, Groups NE₁ and NE₂ had reduced postactivity VAS scores at 48 h postsurgery (p < 0.05). Compared to Group NE₁, Group NE₂ had reduced VAS scores at 12 h and 24 h following surgery (p < 0.05). Compared with Group N, the Ramsay sedation scores were higher in Group NE₁ and Group NE₂ at 6 h, 12 h, and 24 h following surgery (p < 0.05). Compared with Group NE₁, Group NE₂ had higher Ramsay sedation scores at 6 h and 12 h postoperatively (p < 0.05). The total number of analgesic pump presses and the number of effective presses in the NE₁ and NE₂ groups were substantially lower than those in the N group (p < 0.05). Compared with the NE₁ group, the total number of presses and the number of effective presses in the NE₂ group were reduced at 24 h and 48 h postoperatively (p < 0.05). Compared with Group N, the cognitive scores on the MoCA scale were markedly increased in Group NE₁ and Group NE₂ at 6 h, 12 h, and 24 h postoperatively (p  < 0.05). The incidence of vomiting was substantially lower in the NE₁ and NE₂ groups than in the N group at 48 h postoperatively (p < 0.05). The rate of drowsiness was markedly increased in the NE₂ group than in the N and NE₁ groups during the 48 h postoperative period (p < 0.05).

The combination of nalbuphine (2 mg kg^-1) and esketamine (0.5 mg kg^-1) effectively relieves postsurgical pain, reduces the incidence of postoperative PCIA use, and lowers the incidence of adverse events after LC.

ClinicalTrials.gov identifier: ChiCTR2400088373.