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已发表论文
低剂量 S(+) 型氯胺酮在膝关节置换术中的镇痛效果：一项随机对照试验
Authors Deng SY, Song X, Chen LN, Zhao F, Guo L
Received 10 June 2025
Accepted for publication 19 October 2025
Published 4 November 2025 Volume 2025:18 Pages 5815—5826
DOI https://doi.org/10.2147/JPR.S545997
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Karina Gritsenko
Shi-Yuan Deng, Xiao Song, Li-Na Chen, Fei Zhao, Liang Guo
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, 250014, People’s Republic of China
Correspondence: Liang Guo, Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No. 16766 Jingshi Road, Jinan, Shandong, 250014, People’s Republic of China, Email guoliang2033@163.com
Background: Insufficient pain relief during knee joint replacement surgery can have adverse effects on the postoperative recovery of the patient. In this study, we evaluated the analgesic effect of intravenous infusion of low-dose S(+)-ketamine in patients following knee joint replacement surgery.
Methods: This study was a randomized, single-blind, placebo-controlled trial involving 144 patients who underwent knee joint replacement. Patients were randomly assigned to receive an intravenous infusion of S(+)-ketamine (0.3 mg/kg/h) or 0.9% sodium chloride solution. The primary efficacy endpoint was evaluated based on NRS scores at 2 h, 24 h, and 48 h after surgery. Additionally, the intraoperative doses of sufentanil, propofol, and remifentanil were investigated. The number of patients who required analgesic rescue and the number of patients who experienced adverse reactions within 48 h postoperatively were recorded.
Results: S(+)-ketamine reduced NRS scores for movement pain at 2 h [2.36 ± 0.66 vs 3.1 ± 0.65, P < 0.001], 24 h [2.15 ± 0.62 vs 2.79 ± 0.85, P < 0.001], and 48 h [1.81 ± 0.6 vs 2.29 ± 0.76, P < 0.001] postoperatively. Administering S(+)-ketamine reduced the dose of sufentanil [30 (30, 35) vs 40 (35, 40), P < 0.001] but not propofol [333.68 ± 75.02 vs 323.06 ± 79.94, P = 0.412] or remifentanil [1.8 (1.4, 2.2) vs 1.6 (1.325, 2), P = 0.131]. The use of intraoperative S(+)-ketamine significantly reduced the patient proportion of requiring additional analgesics postoperatively (4.2% vs 19.4%, P = 0.004). A lower incidence of dizziness (1.4% vs 12.5%, P = 0.009), nausea (11.1% vs 29.2%, P < 0.001), and vomiting (8.3% vs 29.2%, P = 0.001) was found in patients treated with S(+)-ketamine (P < 0.05).
Conclusion: Intravenous infusion of S(+)-ketamine during surgery of elderly patients undergoing knee joint replacement can alleviate postoperative acute pain, providing research support for the application of S(+)-ketamine in multimodal analgesia.
Trial Registration: NCT05289050.
Keywords: S(+)-ketamine, total knee arthroplasty surgery, elderly patients, analgesia, pain
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, 250014, People’s Republic of China
Correspondence: Liang Guo, Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No. 16766 Jingshi Road, Jinan, Shandong, 250014, People’s Republic of China, Email guoliang2033@163.com
Background: Insufficient pain relief during knee joint replacement surgery can have adverse effects on the postoperative recovery of the patient. In this study, we evaluated the analgesic effect of intravenous infusion of low-dose S(+)-ketamine in patients following knee joint replacement surgery.
Methods: This study was a randomized, single-blind, placebo-controlled trial involving 144 patients who underwent knee joint replacement. Patients were randomly assigned to receive an intravenous infusion of S(+)-ketamine (0.3 mg/kg/h) or 0.9% sodium chloride solution. The primary efficacy endpoint was evaluated based on NRS scores at 2 h, 24 h, and 48 h after surgery. Additionally, the intraoperative doses of sufentanil, propofol, and remifentanil were investigated. The number of patients who required analgesic rescue and the number of patients who experienced adverse reactions within 48 h postoperatively were recorded.
Results: S(+)-ketamine reduced NRS scores for movement pain at 2 h [2.36 ± 0.66 vs 3.1 ± 0.65, P < 0.001], 24 h [2.15 ± 0.62 vs 2.79 ± 0.85, P < 0.001], and 48 h [1.81 ± 0.6 vs 2.29 ± 0.76, P < 0.001] postoperatively. Administering S(+)-ketamine reduced the dose of sufentanil [30 (30, 35) vs 40 (35, 40), P < 0.001] but not propofol [333.68 ± 75.02 vs 323.06 ± 79.94, P = 0.412] or remifentanil [1.8 (1.4, 2.2) vs 1.6 (1.325, 2), P = 0.131]. The use of intraoperative S(+)-ketamine significantly reduced the patient proportion of requiring additional analgesics postoperatively (4.2% vs 19.4%, P = 0.004). A lower incidence of dizziness (1.4% vs 12.5%, P = 0.009), nausea (11.1% vs 29.2%, P < 0.001), and vomiting (8.3% vs 29.2%, P = 0.001) was found in patients treated with S(+)-ketamine (P < 0.05).
Conclusion: Intravenous infusion of S(+)-ketamine during surgery of elderly patients undergoing knee joint replacement can alleviate postoperative acute pain, providing research support for the application of S(+)-ketamine in multimodal analgesia.
Trial Registration: NCT05289050.
Keywords: S(+)-ketamine, total knee arthroplasty surgery, elderly patients, analgesia, pain