ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
S-ketamine Plus Dexmedetomidine Versus S-ketamine Plus Propofol for Sedation– Analgesia During Positioning for Spinal Anesthesia in Older Adults Undergoing Lower-Extremity Fracture Surgery: A Retrospective Cohort Study
Yingying Guo
Tianjiao Wang
Wenyong Han
Beijing Electric Power Hospital, Beijing, China
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Abstract
Background: Positioning for neuraxial anesthesia in geriatric lower extremity fracture surgery is painful and can destabilize hemodynamics. Sedation–analgesia must balance effective analgesia with respiratory safety and physiologic stability. Methods: This single center retrospective cohort study included patients aged ≥65 years undergoing lower extremity fracture surgery under spinal anesthesia who received S ketamine plus dexmedetomidine (Group A, n=48) or S ketamine plus propofol (Group B, n=46). Primary outcomes were 0-10 Numerical Rating Scale (NRS) positioning pain and an ordinal posture-quality score measured at five stages (T1-T5). Repeated measures were analyzed with mixed‑effects models (group, stage, group×stage; random: patient) with covariate adjustment. Stage‑wise contrasts were Holm‑corrected. Results: One hundred records were screened, and 94 patients were analyzed. Group×stage interactions were significant for pain and posture quality. Group A had lower pain during the most noxious stages (T3-T5; adjusted differences -0.42 to -0.50) and higher odds of better posture quality (OR 2.30-2.70). Physiological differences were modest and stage-specific, with slightly higher SpO2 and lower HR/MAP at T2-T3. Postoperative NRS differed only at 12 h. Delirium was identified from routine documentation without a standardized instrument (0/48 vs 2/46). Conclusions: In this retrospective cohort, dexmedetomidine‑based sedation with S-ketamine was associated with improved comfort and cooperation during spinal positioning compared with propofol-based sedation, while adverse events were infrequent in both groups.
Summary
Keywords
Bispectral Index, Dexmedetomidine, Geriatric anesthesia, lower-extremity fracture, positioning, Propofol, S-ketamine, spinal anesthesia
Received
15 September 2025
Accepted
29 January 2026
Copyright
© 2026 Guo, Wang and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yingying Guo
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