The Effects of Different Doses of Nalbuphine and Esketamine on Prevention of Emergence Agitation in Preschool Children Undergoing Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial

作者：Zhangcheng Zou, Hao Guo, Xu Tong, Tingting Ao, Ran Ran · 发表于：Drug Design Development and Therapy · 年份：2026 · DOI：10.2147/dddt.s597263 · 研究领域：Anesthesia and Neurotoxicity Research、Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents

Purpose: Emergence agitation (EA) is a frequent complication in preschool children following adenotonsillectomy. This study evaluated the efficacy of intravenous nalbuphine versus esketamine for EA prophylaxis in this population. Patients and Methods: In this randomized, double-blind trial, 98 children (aged 3– 7 years) undergoing adenotonsillectomy were analysed via a modified intention-to-treat approach. Patients received esketamine 0.25 mg/kg (Group E, n=33), nalbuphine 0.1 mg/kg (Group N1, n=33), or nalbuphine 0.2 mg/kg (Group N2, n=32) approximately 10 minutes before surgery completion. The primary outcome was EA incidence (maximum Pediatric Anesthesia Emergence Delirium [PAED] score ≥ 12 within 30 minutes post-extubation). Secondary outcomes included exploratory longitudinal Face, Legs, Activity, Cry, and Consolability (FLACC) scores, haemodynamics, and adverse events. Results: EA incidence was significantly lower in Group N2 (6.25%) than Group E (39.39%) (Relative Risk [RR] = 0.16; 95% CI: 0.04– 0.65; Bonferroni-adjusted P = 0.006). The difference between Group N1 (21.21%) and Group E was not statistically significant (RR = 0.54; 95% CI: 0.25– 1.18; P = 0.354). Exploratory repeated-measures analyses showed Group N2 provided superior analgesia and more stable heart rates postoperatively compared to Group E ( P = 0.004 for FLACC; P = 0.002 for heart rate). Extubation times and adverse event rates were comparable across groups ( P = 0.482 and P > 0.999, respectively). Con...