Analgesic effect of esketamine in children with postoperative limb fracture and construction of forecasting model

doi:10.11958/20250512

Abstract

Abstract:

Objective To investigate the effect of low-dose esketamine on postoperative analgesia in children with limb fractures and to construct a prediction model. Methods A total of 215 children with limb fractures were selected. After surgery, patients received self-controlled intravenous analgesia (PCIA) with a combination of esketamine and sufentanil. According to the analgesic effect, patients were divided into the good effect group (154 cases) and the poor effect group (61 cases). Logistic regression analysis was used to identify the factors influencing the analgesic effect of esketamine on postoperative analgesia in children with limb fractures. A nomogram was created to evaluate the prediction model. Results Logistic regression identified the following independent risk factors for poor analgesic effect of esketamine: American Society of Anesthesiologists (ASA) classification of level II (OR=2.731, 95%CI: 1.207-6.180), lower limb fractures (OR=2.990, 95%CI: 1.474-6.063), emergency surgery (OR=2.726, 95%CI: 1.284-5.789) and long operation time (OR=1.059, 95%CI: 1.032-1.088). Independent protective factors included preoperative analgesia (OR=0.338, 95%CI: 0.156-0.731) and postoperative ice application (OR=0.761, 95%CI: 0.658-0.879). The prediction model for the analgesic effect was: logit(P) = -8.140 + 1.005 × ASA classification + 1.095 × fracture site + 1.003 × surgical type - 1.086 × preoperative analgesia - 0.274 × postoperative ice application + 0.057 × operation time. In the nomogram, ASA classification II, lower limb fractures, emergency surgery, no preoperative analgesia and no postoperative ice application were assigned 20, 22.5, 20 and 20 points, respectively. For every 10-minute increase in surgery time, the nomogram score increased by 11.5 points. The area under the curve (AUC) for the nomogram model in predicting the analgesic effect of esketamine was 0.827 (95%CI: 0.741-0.852), with a Brier score of 0.146 and a calibration slope of 0.601, indicating good calibration (Hosmer-Lemeshow χ2=2.271, P=0.972). Conclusion Esketamine provides effective postoperative analgesia for children with limb fractures. The constructed nomogram model demonstrates high discrimination and calibration in predicting the analgesic effect in children.

Key words: ketamine, child, extremities, fractures, analgesia, forecasting model

CLC Number:

R614，R726.8

Figures/Tables 5

References 21

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组别	n	性别（男/女）		年龄/ 岁		BMI/ （kg/m²）		ASA分级（Ⅰ级/Ⅱ级）		骨折部位（上肢/下肢）		骨折原因（摔伤/交通事故伤/坠落伤）		骨折类型（开放性/闭合性）		粉碎性骨折
效果良好组	154	80/74		7.13±1.09		17.20±2.17		132/22		89/65		92/38/24		30/124		42（27.3）
效果不佳组	61	31/30		6.92±1.05		17.56±2.08		43/18		21/40		37/13/11		13/48		18（29.5）
χ²或t		0.022		1.287		1.109		6.686^＊		9.547^＊＊		0.375		0.092		0.109
组别	既往骨折史		术前镇痛		术后冰敷		手术类型（急诊/择期）		手术时间/min		麻醉时间/min		术中出血量/mL		艾司氯胺酮剂量（1.0 mg/kg/0.5 mg/kg）
效果良好组	10（6.5）		65（42.2）		106（68.8）		30/124		51.82±13.55		89.67±20.70		17.92±3.57		65/89
效果不佳组	10（16.4）		15（24.6）		26（42.6）		23/38		62.77±15.37		85.05±24.53		18.67±3.24		24/37
χ²或t	5.076^＊		5.804^＊		12.662^＊＊		7.813^＊＊		5.138^＊＊		1.398		1.425		0.148

组别	n	性别（男/女）		年龄/ 岁		BMI/ （kg/m²）		ASA分级（Ⅰ级/Ⅱ级）		骨折部位（上肢/下肢）		骨折原因（摔伤/交通事故伤/坠落伤）		骨折类型（开放性/闭合性）		粉碎性骨折
效果良好组	154	80/74		7.13±1.09		17.20±2.17		132/22		89/65		92/38/24		30/124		42（27.3）
效果不佳组	61	31/30		6.92±1.05		17.56±2.08		43/18		21/40		37/13/11		13/48		18（29.5）
χ²或t		0.022		1.287		1.109		6.686^＊		9.547^＊＊		0.375		0.092		0.109
组别	既往骨折史		术前镇痛		术后冰敷		手术类型（急诊/择期）		手术时间/min		麻醉时间/min		术中出血量/mL		艾司氯胺酮剂量（1.0 mg/kg/0.5 mg/kg）
效果良好组	10（6.5）		65（42.2）		106（68.8）		30/124		51.82±13.55		89.67±20.70		17.92±3.57		65/89
效果不佳组	10（16.4）		15（24.6）		26（42.6）		23/38		62.77±15.37		85.05±24.53		18.67±3.24		24/37
χ²或t	5.076^＊		5.804^＊		12.662^＊＊		7.813^＊＊		5.138^＊＊		1.398		1.425		0.148

因素	β	SE	Wald χ²	P	OR	OR 95%CI
ASA分级	1.005	0.417	5.811	0.016	2.731	1.207~6.180
骨折部位	1.095	0.361	9.220	0.002	2.990	1.474~6.063
既往骨折史	0.800	0.536	2.224	0.136	2.226	0.778~6.370
手术类型	1.003	0.384	6.815	0.009	2.726	1.284~5.789
术前镇痛	-1.086	0.394	7.581	0.006	0.338	0.156~0.731
术后冰敷	-0.274	0.122	5.035	0.022	0.761	0.658~0.879
手术时间	0.057	0.013	18.208	<0.001	1.059	1.032~1.088
常数项	-8.140	1.341	18.838	<0.001	0.010

因素	β	SE	Wald χ²	P	OR	OR 95%CI
ASA分级	1.005	0.417	5.811	0.016	2.731	1.207~6.180
骨折部位	1.095	0.361	9.220	0.002	2.990	1.474~6.063
既往骨折史	0.800	0.536	2.224	0.136	2.226	0.778~6.370
手术类型	1.003	0.384	6.815	0.009	2.726	1.284~5.789
术前镇痛	-1.086	0.394	7.581	0.006	0.338	0.156~0.731
术后冰敷	-0.274	0.122	5.035	0.022	0.761	0.658~0.879
手术时间	0.057	0.013	18.208	<0.001	1.059	1.032~1.088
常数项	-8.140	1.341	18.838	<0.001	0.010