Abstract
OBJECTIVE: To investigate the effects of esketamine combined with quadratus lumborum block (QLB) on postoperative anxiety, depression, and cognitive function in frail older patients undergoing radical colorectal cancer surgery. METHODS: This study included older frail patients scheduled for radical colorectal cancer surgery. Patients were randomly assigned to either the control group, receiving standard anesthesia, or the combination group, receiving QLB combined with esketamine anesthesia. Hemodynamic parameters, anesthetic drug dosages, recovery quality, cognitive function, and pain levels were compared between the two groups. RESULTS: Both groups showed no significant differences in mean arterial pressure (MAP) and heart rate (HR) before anesthesia induction (p > 0.05). However, after induction, during pneumoperitoneum, and postoperatively, the combination group exhibited significantly lower MAP and HR compared to the control group (p < 0.05). The combination group required lower dosages of remifentanil and propofol (p < 0.05), had shorter recovery times and lower agitation scores upon awakening (p < 0.05). Additionally, the combination group had significantly higher Mini-Mental State Examination (MMSE) scores on postoperative days 1 and 3, and lower Visual Analog Scale (VAS) scores for pain at 1, 4, and 12 h post-extubation (p < 0.05). CONCLUSION: Esketamine combined with QLB in Olderfrail patients undergoing radical colorectal cancer surgery stabilizes hemodynamic parameters, reduces anesthetic drug usage, improves recovery quality, mitigates cognitive dysfunction, and alleviates pain. This combined approach is clinically beneficial and warrants further promotion.