Effect of esketamine-based opioid-sparing anesthesia strategy on postoperative pain and recovery quality in patients undergoing total laparoscopic hysterectomy : a randomized controlled trail

Abstract

Abstract Objective Opioid-sparing anesthesia reduces intraoperative use of opioids and reduced adverse postoperative events. The present study investigated the effect of esketamine-based opioid-sparing anesthesia on total laparoscopic hysterectomy patients' recovery. Methods Ninety patients undergoing total laparoscopic hysterectomy were randomly assigned to esketamine-based group (group K) or opioid-based group (group C). Patients, surgeons, and postoperative medical staff were blinded to group allocation. Due to the different drug administration protocols by groups, the anesthesiologist couldn't be blinded. The QoR-40 and VAS were used to measure recovery quality. Postoperative adverse events, perioperative opioid consumption, and intraoperative hemodynamics were secondary endpoints. Results The patients in both groups had comparable baseline characteristics. QoR-40 scores were higher in group K than in group C on postoperative day 1(160.91 ± 9.11 vs 151.47 ± 8.35, respectively; mean difference 9.44 [95%CI: 5.78–13.11]; P < 0.01). Within 24 hours of surgery, group K had lower VAS scores in both at rest and on movement. (P < 0.05 for each). Group K had much lower rates of nausea and vomiting within 24 hours of surgery. (P < 0.05 for each). The total dose of sufentanil and remifentanil were all significantly lower in the group K than in the group C (17.28 ± 2.59 vs 43.43 ± 3.52; 0.51 ± 0.15 vs 1.24 ± 0.24;). The proportion of patients who used ephedrine in surgery was higher in group C than in group K (P < 0.05). Conclusions Esketamine-based opioid-sparing anesthesia strategy is feasible and enhance postoperative recovery by reducing opioid-related side effects and pain scores compared to an opioid- based anesthetic regimen. Trial registration ChiCTR2100051465; Date registered: 24/09/2021.