Esketamine-Based Opioid-Free versus Opioid-Based Anesthesia for Recovery Quality After Laparoscopic Transabdominal Preperitoneal Repair: A Randomized Noninferiority Trial
Drug Design Development and Therapy – January 01, 2026
Source: OpenAlex
Summary
Patients receiving esketamine-based opioid-free anesthesia (OFA) reported better postoperative recovery than those on opioid-based anesthesia (OBA) after laparoscopic surgery. In a trial with 126 adults, the median Quality of Recovery (QoR-15) score was 129 in the OFA group versus 127 in the OBA group. Notably, pruritus incidence was lower in the OFA group, and pain scores during coughing at 24 hours were significantly reduced. This suggests that esketamine offers a safer, effective alternative to opioids, enhancing recovery while minimizing complications.
Abstract
Purpose: This study aimed to compare the quality of postoperative recovery between esketamine-based opioid-free anesthesia (OFA) and opioid-based anesthesia (OBA) in patients undergoing laparoscopic transabdominal preperitoneal (TAPP) repair. Patients and Methods: In this prospective, randomized, double-blind, noninferiority trial, 126 adults scheduled for elective laparoscopic TAPP repair were randomized to OFA (n = 63) or OBA (n = 63) group. The OFA group received esketamine (0.5 mg·kg − 1 induction, 0.4– 0.5 mg·kg − 1 ·h − 1 maintenance), while the OBA group received sufentanil (0.4 μg·kg − 1 induction) and remifentanil (0.1– 0.2 μg·kg − 1 ·min − 1 maintenance). The primary outcome was the 15-item Quality of Recovery (QoR-15) score at 24 hours postoperatively, with a noninferiority margin of − 8. Secondary outcomes included pain scores, rescue analgesia, sleep quality, safety outcomes. Results: The OFA group showed a higher QoR-15 score at 24 hours postoperatively than the OBA group (median difference: 2; median [IQR]: 129 [125 to 132] vs 127 [123 to 130]; 95% CI, 0 to 4; P =0.014). Pruritus incidence was lower ( P =0.027), vasopressor use was reduced (P = 0.012), and hypotensive episodes tended to be fewer ( P =0.106) in the OFA group. Pain scores on coughing at 24 and 48 hours postoperatively were also lower in the OFA group ( P =0.002 and P < 0.001, respectively). Conclusion: Esketamine-based OFA provided a noninferior quality of postoperative recovery compared with OBA in patients undergoing laparoscopic TAPP repair, offering a safer alternative to OFA regimens that minimizes opioid-related complications while maintaining perioperative comfort and supporting enhanced recovery. Keywords: esketamine, transabdominal preperitoneal, noninferiority trial, opioid-free anesthesia, postoperative recovery