Esketamine-based PCIA combined with intercostal nerve block for acute pain after lobectomy: a randomized controlled trial
Frontiers in Pharmacology – March 04, 2026
Source: OpenAlex
Summary
A moderate dose of esketamine (0.03 mg/kg/h) significantly reduces acute postoperative pain (APP) in patients undergoing thoracoscopic lobectomy, lowering pain scores by about 30% at 24 hours compared to sufentanil alone. In a study involving 360 patients, the incidence of APP within 72 hours was notably lower in the esketamine group. Additionally, this group experienced fewer adverse effects like postoperative nausea and vomiting than those receiving sufentanil, highlighting the benefits of combining esketamine with preoperative intercostal nerve block for enhanced pain management.
Abstract
Objective To evaluate outcomes of different doses of esketamine in postoperative patient-controlled intravenous analgesia (PCIA) combined with preoperative intercostal nerve block (ICNB) analgesia protocol for acute postoperative pain (APP) relief in patients undergoing thoracoscopic lobectomy. Materials and methods A total of 360 patients scheduled for thoracoscopic lobectomy at Xuzhou Central Hospital between October 2021 and July 2023 were enrolled and randomly assigned into three groups using the random envelope method. Before anesthesia induction, all patients received ICNB, followed by general anesthesia. Group C received PCIA using sufentanil at 0.03 μg/kg/h, Group K1 received a low dose of esketamine at 0.015 mg/kg/h in PCIA, and Group K2 received a moderate dose of esketamine at 0.03 mg/kg/h in PCIA. Numerical Rating Scale (NRS) pain scores were recorded at 2, 4, 24, 48, and 72 h postoperatively. The incidence of APP within 72 h post-surgery, the requirement for rescue analgesia and the occurrence of adverse reactions, were assessed and recorded for the three groups. Results There were significantly lower NRS scores in Group K2 at 2, 4, 24, 48, and 72 h postoperatively, compared to Groups C and K1 (P < 0.01). However, there were no statistically significant differences in NRS scores between Group C and Group K1 (P > 0.05). The incidence of APP within 72 h postoperatively was significantly lower in Group K2, compared to Group C and Group K1 (P < 0.05). Additionally, Group C exhibited a significantly higher the incidence of postoperative nausea and vomiting (PONV) than the other two groups (P < 0.05). Group K2 demonstrated superior postoperative analgesic efficacy, including reduced rescue analgesia needs and lower opioid consumption, without affecting hospital stay length compared to Groups C and K1. Conclusion A dose of 0.03 mg/kg/h esketamine in PCIA combined with preoperative ICNB significantly alleviates APP in patients undergoing thoracoscopic lobectomy, reducing resting pain scores by approximately 30% at 24 h compared to sufentanil-based analgesia. Clinical Trial Registration https://www.chictr.org.cn/ , Identifier ChiCTR2100051000.