Esketamine improves pain management following thoracic surgery

A recent study published in the Pain Physician Journal found that intraoperative intravenous esketamine not just reduces postoperative opioid consumption in patients undergoing thoracic surgery, but also improves the quality of perioperative recovery.

Postoperative pain management is essential for patients undergoing thoracic surgery, and opioids are a cornerstone in managing postoperative pain. However, their use may be limited by many adverse events. Recent studies have shown that the perioperative application of esketamine adjuvant therapy can reduce postoperative opioid consumption. This study by Jingjing Yuan and peers explored the opioid-sparing effect of different doses of esketamine infusion during thoracic surgery and its impact on patient recovery.

The study design was a randomized controlled study conducted in a single center with a total of 120 patients. Patients were randomly allocated to three groups: group K1 received intraoperative intravenous infusions of esketamine at 0.15 mg/kg/h, group K2 received esketamine at 0.25 mg/kg/h, and group C received a placebo. The postoperative opioid consumption and postoperative recovery indicators were recorded for each group.

The results of the study showed that the consumption of hydromorphone during the first 24 and 48 postoperative hours was significantly reduced in patients of group K2 compared to those of group C and group K1.

The time to extubation and post-anesthesia care unit (PACU) stay were significantly shorter in group K2 than in group K1 and group C. The time to first feed and off the bed time after surgery were shorter in groups K1 and K2 than in group C.

Moreover, patients in group K2 were significantly more satisfied with patient-controlled intravenous analgesia (PCIA) than in groups K1 and C.

The findings suggest that intraoperative intravenous esketamine at 0.25 mg/kg/h reduced postoperative opioid consumption by 34% in postoperative 24 hours and 30% in postoperative 48 hours in patients undergoing thoracic surgery.

Source:

Yuan, J., Chen, S., Xie, Y., Wang, Z., Xing, F., Mao, Y., Wang, J., Yang, J., Li, Y., & Fan, X. (2022). Intraoperative Intravenous Infusion of Esmketamine Has Opioid-Sparing Effect and Improves the Quality of Recovery in Patients Undergoing Thoracic Surgery: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain physician, 25(9), E1389–E1397.