Objective To observe the effect of dexmedetomidine combined with sub-anesthetic esketamine on stress reaction of elderly patients with percutaneous vertebroplasty.

Methods A total of 120 elderly patients with elective percutaneous vertebroplasty were selected as research objects, and they were randomly divided into control group, dexmedetomidine group, esketamine group and combined group, with 30 cases in each group. In the dexmedetomidine group and the combined group, 0.5 μg/kg dexmedetomidine was pumped intravenously at 10 min before local anesthesia, and then 0.25 μg/(kg·h) dexmedetomidine was pumped continuously for anesthesia maintenance; in the esketamine group and the combined group, 0.25 mg/kg esketamine was used; before operation, the patients in four groups were given 1% lidocaine hydrochloride for local infiltration anesthesia. The vital signs, score of Visual Analogue Scale (VAS) for pain and Ramsay score for sedation were recorded at the time points of 5 minutes after entering the operating room (T₀), the beginning of surgery (T₁), the puncture needle reaching the vertebral body (T₂), injection of bone cement (T₃), the end of surgery (T₄) and before returning to the ward (T₅); the levels of plasma cortisol (Cor), blood glucose (Glu), plasma epinephrine (E) and norepinephrine (NE) were measured at T₀, T₁, T₃ and T₄.

Results Compared with T₀ and the dexmedetomidine group, the mean arterial pressure (MAP) and heart rate (HR) at T₁ to T₃ in the control group were significantly higher (P < 0.05); compared with the control group, the MAP and HR at T₁ to T₃ in the dexmedetomidine group, the esketamine group and the combined group decreased significantly (P < 0.05). Compared with T₀, the VAS scores at T₂ to T₃ in the control group increased significantly, while the VAS scores at T₂ to T₅ in the dexmedetomidine group and the esketamine group as well as at T₁ to T₅ in the combined group decreased significantly (P < 0.05); compared with T₀ and the control group, the Ramsay scores at T₁ to T₅ in the dexmedetomidine group, the esketamine group and the combined group were significantly higher (P < 0.05). Compared with T₀, the levels of plasma Cor and Glu at T₁, T₃ and T₄ in the control group, the dexmedetomidine group and the esketamine group were significantly higher (P < 0.05); compared with the control group, the levels of plasma Cor and Glu at T₁, T₃ and T₄ in the dexmedetomidine group, the esketamine group and the combined group were significantly lower (P < 0.05); compared with T₀, the levels of plasma E and NE at T₁, T₃ and T₄ in the control group as well as at T₁ and T₃ in the dexmedetomidine group and the esketamine group were significantly higher (P < 0.05); compared with the control group, the levels of plasma E and NE at T₁, T₃ and T₄ in the dexmedetomidine group, the esketamine group and the combined group were significantly lower in abore indicators (P < 0.05).

Conclusion The sedative and analgesic effect of dexmedetomidine combined with sub-anesthetic esketamine is definite in elderly patients with percutaneous vertebroplasty, which can alleviate the stress reaction and promote rapid recovery after operation.