Impact of esketamine-based opioid-free anesthesia on quality of recovery after laparoscopic hysterectomy: a randomized controlled trial using the QoR-40 questionnaire.

Abstract

<h4>Objective</h4>In patients undergoing laparoscopic hysterectomy, this study compared two anesthetic approaches-esketamine-based opioid-free anesthesia and opioid-based anesthesia-to assess their impact on postoperative recovery quality.<h4>Patients and methods</h4>This prospective trial randomly assigned 91 patients undergoing laparoscopic hysterectomy to receive either esketamine-based anesthesia (induction and maintenance with esketamine, without perioperative opioids) or conventional opioid-based anesthesia. The primary endpoint was defined as the Quality of Recovery-40(QoR-40) score measured on postoperative day (POD) 1. Secondary measures comprised the QoR-40 score on POD 3, pain scores after surgery, hemodynamic variables, and adverse events.<h4>Results</h4>On POD1, compared to the opioid group, the esketamine group exhibited a significantly elevated QoR-40 score (p < 0.001), but scores were similar by POD3 (p = 0.333). The esketamine group experienced a lower rate of postoperative nausea and vomiting (PONV) (17.8% vs. 37.0%, p = 0.040), whereas the two groups had comparable pain scores at every time point measured (all p > 0.05).<h4>Conclusion</h4>Among laparoscopic hysterectomy patients, esketamine-based opioid-free anesthesia was linked to higher POD1 QoR-40 scores and fewer PONV events than opioid-based anesthesia. However, given the modest sample size, these preliminary findings warrant confirmation in larger multicenter trials.<h4>Trial registration</h4>We prospectively registered the study protocol in the Chinese Clinical Trial Registry. (ChiCTR2300075661) on September 12, 2023.

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