Esketamine as a Perineural Adjuvant to Ropivacaine for Pericapsular Nerve Group (PENG) Block in Elderly Patients Undergoing Hip Fracture Surgery: A Propensity Score-Matched Retrospective Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Purpose: Hip fractures are increasing with global aging. We evaluated esketamine as a perineural ropivacaine adjuvant for PENG block on early recovery quality and analgesia in elderly hip fracture surgery patients. Patients and Methods: In this retrospective cohort study (July 2024–May 2025), 252 elderly patients undergoing hip fracture surgery under general anesthesia were included. Patients were allocated to control or esketamine groups based on adjuvant use. Propensity score matching yielded 86 pairs. The primary outcome was QoR-15 scores at multiple postoperative time points; secondary outcomes included sensory block duration, sleep quality, pain scores, and adverse events. Results: At 24 and 48 hours, QoR-15 scores were higher with esketamine (median difference, 9 [95% CI, 7– 11] and 4 [95% CI, 2– 6]). Sensory block was prolonged (16.51 ± 1.30 vs 10.91 ± 1.26 hours; P < 0.001). On day 1, sleep quality and VAS pain scores improved (both P < 0.001), but neither difference exceeded the population-specific MCID. Time to first ambulation was shorter, and intraoperative propofol and remifentanil use was lower (both P < 0.001). Frailty, age, anxiety, and higher aCCI predicted unfavorable recovery trajectories. Conclusion: Among elderly patients undergoing hip fracture surgery, esketamine added to ropivacaine for PENG block improved 24-hour recovery quality (QoR-15, exceeding MCID; 48-hour scores higher but below MCID), prolonged sensory block, shortened time to first ambulation, and reduced intraoperative anesthetic and opioid use. Sleep and analgesia improved only at 24 hours but did not exceed population-specific MCIDs. No difference in adverse events was detected within sample size constraints. In an exploratory latent trajectory analysis of the control group, frailty, age, anxiety, and aCCI predicted poor recovery. Keywords: esketamine, Hip fractures, geriatric patients, pericapsular nerve group block
DOI: 10.2147/dddt.s641258
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W7223654944