The use of Esketamine in CT-guided percutaneous liver tumor ablation reduces the consumption of remifentanil: a randomized, controlled, double-blind trial

Abstract

Background: In the anesthesia management of percutaneous liver tumor ablation, the requirement of analgesia is very strict. Currently, intravenous anesthesia is commonly used, such as remifentanil combined with sedative drugs. However, the pain relief is not instantaneous after increasing the dosage of remifentanil. Esketamine, a medium- or long-term analgesic drug, does not inhibit respiration to maintain patient comfort during the ablation and reduces the consumption of remifentanil. Therefore, this experiment was designed to investigate the potential of combinational therapy and the most appropriate dose of esketamine.

Methods: A total of 120 patients were randomly divided into three groups by SPSS. The regular anesthesia model included dexmedetomidine 0.5 µg/kg, intravenous glucose tolerance test, remifentanil continuous infusion, flurbiprofen 50 mg, i.v., palonosetron 0.225 mg, i.v., and 1% lidocaine for local anesthesia. Group A was the regular control group, only using the regular model; Group B also received with 0.1 mg/kg esketamine, i.v.; and Group C also received 0.2 mg/kg esketamine, i.v.. The whole experiment was double-blind.

Results: From December 2020 to March 2021, 120 patients were randomized in total, and 108 were included in the analysis: 36, 37, 35 were allocated to Group A, Group B, and Group C, respectively. The total dosage of remifentanil in Group A, Group B, Group C was 179.38±123.37, 120.31±57.96 and 115.91±62.42 µg, respectively. We found the total dosage of remifentanil in Group B and Group C were significantly decreased in comparison to that of Group A (P=0.004, P=0.003, respectively). The maximum dosage of remifentanil in Group A, Group B, and Group C was 1.76±0.62, 1.37±0.47, and 1.33±0.56 ng/mL, respectively. The maximum dosage of remifentanil in Group B and Group C were significantly decreased in comparison to that of Group A (P=0.003, P=0.001, respectively). The incidence of severe pain during the ablation in Group B was significantly lower than that in Group A (3 vs. 12, P<0.05).

Conclusions: The use of esketamine can reduce the dosage of opioids for liver tumor ablation and reduce the occurrence of severe pain. We found that 0.1 mg/kg esketamine, i.v. is the most suitable dose for liver tumor ablation.

Trial registration: Chinese Clinical Trial Registry ChiCTR2100049152.

Keywords: Esketamine; ablation; analgesia; liver tumor; sedation.

Figure 1

The admission flowchart of patients. In Group A, three patients were excluded by the change of the operation, one was excluded by the missing visit. In Group B, one patient had more than three liver tumors, and two patients had undergone ablations more than three times previously. In Group C, one patient was excluded by the change of the operation, one patient’s operation was canceled, two patients refused to participate in our trial, and one patient had more than three liver tumors. All these patients mentioned above were excluded.

Figure 2

The consumption of remifentanil in three groups. (A) The total dosage of remifentanil in three groups; (B) the maximum dosage remifentanil in three groups. **, P<0.01. Group A: the regular control group. Group B: 0.1 mg/kg esketamine, i.v.. Group C: 0.2 mg/kg esketamine, i.v..

Figure 3

The vital signs in the three groups. (A) The SBP in three groups during T0–T8; (B) the DBP in three groups during T0–T8; (C) the MBP in three groups during T0–T8; (D) the HR in three groups during T0–T8; (E) the RR in three groups during T0–T8; (F) the SpO₂ in three groups during T0–T8. SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; HR, heart rate; RR, respiratory rate; SpO₂, saturation of peripheral oxygen. Group A: the regular control group. Group B: 0.1 mg/kg esketamine, i.v.. Group C: 0.2 mg/kg esketamine, i.v..

Figure 4

The consumption of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was no more than 1 cm. (A) The total dosage of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was no more than 1 cm; (B) the maximum dosage of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was no more than 1 cm. **, P<0.01; *, P<0.05. Group A: the regular control group. Group B: 0.1 mg/kg esketamine, i.v.. Group C: 0.2 mg/kg esketamine, i.v..

Figure 5

The consumption of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was more than 1 cm. (A) The total dosage of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was more than 1 cm; (B) the maximum dosage of remifentanil in three groups when the minimum distance from the tumor to the capsule (d) was more than 1 cm. Group A: the regular control group. Group B: 0.1 mg/kg esketamine, i.v.. Group C: 0.2 mg/kg esketamine, i.v..