Intraoperative esketamine infusion and postoperative sleep quality after shoulder arthroscopy: a randomized controlled trial.

Abstract

<h4>Background</h4>Sleep disturbance is common after shoulder arthroscopy and may impair postoperative recovery. Whether intraoperative esketamine infusion improves postoperative sleep quality in this population remains unclear.<h4>Methods</h4>In this single-center, randomized, double-blind, controlled trial, adult patients with preoperative sleep disturbance undergoing shoulder arthroscopy were assigned (1:1) to receive intraoperative esketamine infusion (0.3 mg/kg/h) or placebo. The primary outcome was sleep disturbance (Athens Insomnia Scale [AIS] ≥6) on postoperative day 1 (POD1). Secondary outcomes included subjective and objective sleep parameters, pain scores, psychological outcomes, and adverse events.<h4>Results</h4>Eighty patients were included. The incidence of sleep disturbance on POD1 was significantly lower in the esketamine group compared with the placebo group (5.0% vs. 27.5%; risk ratio 0.18, 95% confidence interval 0.04-0.77). Wearable-derived monitoring on POD1 showed a longer device-estimated total sleep time in the esketamine group (<i>P</i> < 0.001). Exploratory device-estimated sleep-stage parameters also favored the esketamine group (all <i>P</i> < 0.001). Subjective sleep measures also favored the esketamine group, which had lower Athens Insomnia Scale scores on POD1, POD3, and POD7 (all P < 0.05). At POD30, the PSQI score remained lower in the esketamine group than in the placebo group (5.5 (4.0-8.0) vs. 8.0 (6.0-8.3); P = 0.001).<h4>Conclusion</h4>In this single-center randomized trial, intraoperative esketamine infusion was associated with reduced early postoperative sleep disturbance in patients undergoing shoulder arthroscopy. These preliminary findings warrant confirmation in larger multicenter trials.<h4>Clinical trial registration</h4>MR-33-26-017245 (https://www.medicalresearch.org.cn/).

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