Effect of Esketamine for Patient-Controlled Intravenous Analgesia on Postoperative Sleep Disturbance in the Elderly After Total Hip or Knee Arthroplasty: A Prospective, Randomized, Double-Blind, and Controlled Trial.
The Journal of arthroplasty – June 06, 2025
Source: PubMed
Summary
Elderly patients undergoing hip or knee replacements often struggle with poor sleep after surgery, which can slow their recovery. Adding esketamine to standard pain medication significantly improved sleep quality and reduced anxiety in these patients. The medication helped them sleep better for three days after surgery, required fewer pain interventions, and sped up recovery—all without increasing side effects.
Abstract
Postoperative sleep disturbance (PSD) commonly affects elderly patients, impairing recovery. This study investigated the effect of esketamine for patient-controlled intravenous analgesia (PCIA) on PSD in elderly patients who had total hip arthroplasty (THA) or total knee arthroplasty (TKA). In this trial, 120 elderly patients who underwent THA or TKA were randomized to patient-controlled sufentanil analgesia (two μg kg-1 in normal saline to 100 ml) or a supplement (esketamine 0.72 mg kg-1). The primary outcome was the incidence of PSD on postoperative day (POD) one. A PSD was defined as a numeric rating scale (NRS) score of 6 or higher or an Athens Insomnia Scale (AIS) score of 6 or higher. The secondary outcomes included the incidence of PSD on postoperative days (PODs) two, three, and seven; postoperative subjective sleep quality; anxiety and depression; cognitive function; the number of PCIA attempts; rescue analgesics within 48 hours, postoperative delirium, and quality of recovery. Also, nausea and vomiting; and other adverse events were compared. There were 112 patients included in the per-protocol analysis. The incidence of PSD was lower in the esketamine group compared to the sufentanil group on POD one (P = 0.002), POD two (P = 0.018), and POD three (P = 0.025). Compared with the sufentanil group, the esketamine group had lower anxiety and depression scores on PODs one, two, and three (P 0.05), incidence of postoperative delirium (P > 0.05), and adverse events between the two groups. Esketamine (0.72 mg kg-1) as a supplement in PCIA safely prevents the incidence of PSD, improves analgesia, relieves anxiety and depression, and accelerates postoperative recovery in elderly patients who had THA or TKA. ChiCTR2400085319.