Effect of Esketamine Combined with Oxycodone in Postoperative Pain Management in Elderly Patients Undergoing Abdominal Surgery: A Double-Blind Randomized Trial
Abstract
<title>Abstract</title> <p> Background Moderate to severe pain is common after major abdominal surgery in older adults. Both oxycodone and esketamine can alleviate pain, but they may cause adverse effects. We hypothesized that adding esketamine to an oxycodone-based analgesic regimen would further reduce postoperative pain. Methods This randomized, double-blind trial enrolled 180 patients undergoing major abdominal surgery. They were randomly assigned to receive patient-controlled analgesia (PCA) with either esketamine combined with oxycodone (oxycodone 0.5 mg/kg + esketamine 0.5 mg/kg in saline to 100 mL) or oxycodone alone (0.5 mg/kg in saline to 100 mL). The primary outcome was the incidence of moderate-to-severe pain within 72 hours postoperatively (numerical rating scale, NRS). Secondary outcomes included subjective sleep quality (NRS) during the first three postoperative nights and the use of rescue analgesia. Results Intention-to-treat analysis included 179 patients. The combination group had a lower incidence of moderate-to-severe pain (30.3% [27/89]) than the oxycodone-only group (51.1% [46/90]; RR 0.59; 95% CI 0.41–0.86; P = 0.005). It also showed lower resting and movement pain intensities at six time points (median difference − 1 point; <italic>P</italic> < 0.007 for both), better sleep quality on the first two postoperative nights (median difference − 2 to 0; <italic>P</italic> < 0.001), and fewer PCA bolus requests and Riker episodes. Adverse event rates were similar between groups. Conclusions The combination of esketamine and oxycodone safely improved analgesic efficacy and subjective sleep quality in elderly patients following abdominal surgery. </p>
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