The Effects of Different Doses of Intravenous Esketamine on Postoperative Sleep and Chronic Pain in Patients Undergoing Thoracoscopic Lung Resection Surgery: A Randomized Controlled Trial
Abstract
<title>Abstract</title> <p> Background Intraoperative esketamine infusion facilitates recovery after thoracoscopic surgery, the optimal dosing and administration regimen remain to be established. We evaluate the effects of varying doses of intravenous esketamine on postoperative sleep and chronic pain in patients undergoing thoracoscopic lung resection. Methods Screened patients were randomly assigned to three groups by using random number sequence (n = 30 per group): the high-dose esketamine group (induction: esketamine 0.5 mg·kg⁻¹, maintenance: 0.5 mg·kg⁻¹·h⁻¹), the low-dose esketamine group (induction: esketamine 0.5 mg·kg⁻¹, maintenance: 0.25 mg·kg⁻¹·h⁻¹), and the normal saline group (equivalent volume of normal saline administered). Postoperative sleep quality was assessed on postoperative days (POD) 1 and 3 using the Athens Insomnia Scale (AIS). Chronic pain was evaluated at 3 and 6 months postoperatively using the Numerical Rating Scale (NRS). Results A total of 90 patients were enrolled and eventually 89 cases were analyzed. There were no significant differences among the three groups regarding preoperative baseline characteristics or baseline AIS scores. On POD 1, the incidence of postoperative sleep disturbance (PSD) among groups differed significantly, the PSD incidence in the low-dose esketamine group was lower than that in the normal saline group ( <italic>P</italic> = 0.015). On POD 3, AIS scores differed significantly among the groups, the AIS score in the low-dose esketamine group was lower than that in the normal saline group ( <italic>P</italic> = 0.042). However, no significant differences in NRS scores for chronic pain were observed at 3 or 6 months postoperatively among the groups. Conclusions Low-dose esketamine infusion improves postoperative sleep quality in patients undergoing thoracoscopic lung resection surgery but exhibits no preventive effect on chronic pain. Trial registration This trial was retrospectively registered on China Clinical Trial Registry. (Website http//www.chictr.org.cn, ChiCTR2500095258) on January 3, 2025. </p>
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