Abstract:Objective To explore the effects of prophylactic analgesia with esketamine on pain, hemodynamics, and stress response in patients with single-segment thoracolumbar fracture after percutaneous pedicle screw fixation (PPSF). Methods From April 2021 to April 2023, 85 patients with single-segment thoracolumbar fracture undergoing PPSF at The Sixth People's Hospital of Nantong were enrolled as the research objects. All patients underwent PPSF under tracheal intubation and general anesthesia, routine anesthesia induction, maintenance and patient controlled intravenous analgesia. Among all the patients, 42 cases in obeservation group were given intravenous injection of esketamine (10 mg) at 20 min before the end of the surgery, 43 cases in control group did not receive any other treatment. The postoperative pain ［visual analogue scale (VAS)］, hemodynamics ［heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂), respiratory rate］, stress response ［eosinophils (EOS), platelet count (PLT)］ and adverse reactions were compared between the two groups. Results Compared with control group, obeservation group had higher HR and lower MAP immediately after surgery(T1), lower VAS scores at 2 h (T2) and 6 h (T3) after surgery, and lower frequency of analgesic pump compression at 48 h after surgery (P＜0.05). There was no significant difference in SpO₂, respiratory rate between two groups (P＞0.05). At T1 and T3, EOS was higher, while PLT was lower in observation group than control group (P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group (9.52% vs 4.65%, χ²=0.206, P=0.433). Conclusion Prophylactic analgesia with esketamine is beneficial to relieve short-term pain, stress response and stabilize hemodynamics in patients with single-segment thoracolumbar fracture after PPSF, which has few effects on postoperative cognitive function and good safety.