Effects of Intravenous Subanesthetic-Dose Esketamine on Early Postoperative Pain in Elderly Patients Undergoing Thoracoscopic Lung Surgery: A Randomized Double-Blind Controlled Trial.

Abstract

<h4>Purpose</h4>Thoracic surgery is one of the postoperative surgical procedures with the most severe pain. This study aimed to assess whether intraoperative subanesthetic esketamine could reduce the proportion of elderly patients experiencing moderate-to-severe pain following thoracoscopic lung resection.<h4>Patients and methods</h4>A total of 136 elderly patients undergoing thoracoscopic pulmonary surgery were randomly assigned to two groups: the esketamine group (0.25 mg/kg loading, 0.25 mg/kg/h infusion) and the control group (received normal saline). The primary outcome was the proportion of patients experiencing moderate-to-severe pain on the first postoperative day (POD1), defined as a Numerical Rating Scale (NRS) pain score ≥4 during coughing. The secondary outcomes were the postoperative Athens Insomnia Scale (AIS), Hospital Anxiety and Depression Scale (HADS) scores, opioid consumption, hemodynamics, and adverse events.<h4>Results</h4>The primary outcome incidence was lower in the esketamine group (51.5% [35/68]) than in the control group (69.1% [47/68]; relative risk [RR], 0.75; 95% confidence interval [CI], 0.56-0.99; P = 0.035). The proportion of patients with moderate-to-severe pain in the esketamine group decreased by 25.5%. The analysis revealed an absolute risk reduction (ARR) of 17.6% and a number needed to treat (NNT) of 5.7 (rounded to 6). The incidence of postoperative sleep disturbance (PSD) on POD1 (23.5% vs 44.1%; RR, 0.53; 95% CI, 0.32-0.88; <i>P</i> = 0.011) is lower in patients who receive esketamine. Compared to the control group, the esketamine group demonstrated lower HADS scores and reduced opioid consumption, without significant differences in hemodynamic parameters or an increased incidence of neuropsychiatric adverse events.<h4>Conclusion</h4>This study demonstrated that intraoperative subanesthetic esketamine reduced the proportion of moderate-to-severe pain in elderly patients after thoracoscopic surgery, decreased the incidence of sleep disturbances, improved anxiety and depression scores, and lowered opioid consumption, without increasing neuropsychiatric adverse events.

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