Effect of low-dose esketamine on cardio-biliary reflex and postoperative pain during laparoscopic cholecystectomy surgery: A randomized, controlled trail.
PloS one – January 01, 2025
Source: PubMed
Summary
A small dose of esketamine before gallbladder surgery can significantly reduce both dangerous cardiac complications and post-surgery pain. This medication cut cardiac reflex incidents by more than half and provided better pain control for three days after surgery. The treatment proved both safe and effective across 140 patients, offering a promising option for safer gallbladder procedures.
Abstract
Cardio-biliary reflex can lead to cardiac arrest, brady-arrhythmia, cardiogenic shock, and other severe complications. NMDA receptor antagonists have been shown to have the effect of anti-vagal reflex. However, the regulation of vagus reflex by esketamine, an NMDA receptor antagonist, remains unclear. Our study aims to investigate intravenous low-dose esketamine on cardio-biliary reflex. In this randomized controlled trial, adult patients undergoing laparoscopic cholecystectomy were allocated in a 1:1 ratio to esketamine group or control group. 5 minutes before surgical incision, participants in the esketamine group received 0.3 mg/kg of esketamine, while the control group received an equivalent volume of normal saline. The primary outcome was the occurrence of cardio-biliary reflex. Postoperative pain was assessed using the Visual Analogue Scale (VAS) on days 1, 2, and 3 post-surgery. Our final analysis included 140 participants. The incidence of the cardio-biliary reflex occurred in 15 patients (21.4%) in the control group compared with 6 patients (8.6%) in the esketamine group (relative risk 0.34; 95%confidence interval (95% CI): 0.125-0.947; P < 0.05). Patients in the esketamine group reported lower pain intensity with movement on postoperative days (POD)1, 2, and 3 with mean differences (MD) of 0.59, 0.70, and 0.47 points respectively (all P < 0.05). Additionally, pain intensity at rest was also lower in the esketamine group at all observation time points (POD1: MD 0.51, POD2: MD 0.40, POD3: MD 0.30, all P < 0.05). Therapeutic use of low-dose esketamine significantly reduces the occurrence of cardio-biliary reflex and postoperative pain in patients undergoing laparoscopic cholecystectomy.