Comparative study of dexmedetomidine and esketamine in elderly patients undergoing percutaneous vertebroplasty

Background: The study aims to compare the effectiveness of intravenous dexmedetomi-dine and intravenous esketamine on sedation and analgesia in elderly patients undergoing percutaneous vertebroplasty (PVP). Methods: We conducted a retrospective analysis of clinical data from 60 elderly patients with osteoporotic fractures who underwent percutaneous vertebroplasty at our institution. For comparision, the patients were divided into two groups: the dexmedetomidine group and the esketamine group. Each group comprised 30 patients. Results: The Ramsay scores at T2 and T3 for patients in the esketamine group (3.73 ± 0.74, 4.20 ± 0.60) were significantly higher than those in the dexmedetomidine group (3.30 ± 0.65, 3.80 ± 0.76) (p < 0.05). Conversely, the visual analog scale (VAS) scores at T3 and T4 for patients in the esketamine group (3.77 ± 0.73, 2.97 ± 0.49) were lower than those for the dexmedetomidine group (4.40± 0.77, 3.50 ± 0.51) (p < 0.05). There was no statistically significant difference in blood oxygen saturation (SpO2) between the two groups at all time points (p > 0.05). Additionally, the mean arterial pressure (MAP) and heart rate (HR) of patients in the esketamine group were higher than those in the dexmedetomidine group at T2 and T3 (p < 0.05). Furthermore, there was no significant difference in intraoperative bleeding between the two groups (p > 0.05), while patients in the esketamine group experienced shorter hospitalization times and earlier ambulation compared to those in the dexmedetomidine group. Moreover, there was no significant difference in the incidence of adverse reactions or overall satisfaction between the two groups (p > 0.05). Conclusions: Both dexmedetomidine and esketamine, when combined with local anesthesia, demonstrated positive outcomes in PVP for elderly patients. However, esketamine combined with local anesthesia offered superior analgesia and enhanced hemodynamic stability in patients, but also leading to a deeper degree of sedation.

Dexmedetomidine; Esketamine; Percutaneous vertebroplasty; Sedation; Analgesia

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