Effects of sub-anesthetic doses of esketamine on postoperative sleep disturbance and pain in patients undergoing lumbar interbody fusion - A randomized, double-blind, placebo-controlled, two-center trial.
Anaesthesia, critical care & pain medicine – June 14, 2025
Source: PubMed
Summary
Many patients struggle with poor sleep and pain after surgery, especially lumbar spine procedures. A recent trial explored if low-dose esketamine could help. It found that patients receiving esketamine experienced significantly less postoperative sleep disturbance and reduced pain after lumbar interbody fusion. This approach, part of multimodal analgesia, also improved overall recovery, offering a promising strategy for enhanced patient comfort.
Abstract
Postoperative sleep disturbance (PSD) is a common postoperative complication that significantly impacts patients' recovery, particularly after lumbar surgery. This two-center, double-blind, placebo-controlled randomized trial was conducted between June 6, 2024, and November 26, 2024, in two hospitals in China. A total of 80 patients participated in this study and were randomly assigned to the esketamine group (n = 40) or the placebo group (n = 40). Patients in the esketamine group received 0.2 mg kg-¹ of esketamine for anesthesia induction, with a maintenance rate of 0.02 mg kg-¹·h-¹, followed by 1 mg kg-¹ of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the placebo group of patients. The primary outcome of this study was the incidence of PSD on postoperative day (POD) 1. PSD was defined as a Numeric Rating Scale-sleep score of 6 or higher or an Athens Insomnia Scale score of 6 points or higher. The incidence of PSD on POD 1 was significantly lower in the esketamine group compared to the placebo group (33% vs. 67%; P = 0.003). Notably, the Visual Analog Scale (VAS)-pain score at rest was lower in the esketamine group compared to the placebo group at 1, 3, and 6 h after surgery (P < 0.05); moreover, the VAS-pain score with movement was also lower in the esketamine group than the placebo group at 1, 3, 6, and 24 h after surgery (P < 0.05). Furthermore, the Quality of Recovery-15 (QoR-15) scores were significantly higher in the esketamine group than in the placebo group on POD 1 (107 [103- 117] vs. 99 [96-108]; P = 0.005) and POD 3 (130 [122-136] vs. 124 [117-127]; P = 0.003). Sub-anesthetic doses of esketamine can reduce the incidence of PSD on POD1, reduce postoperative pain, and improve QoR. Chinese Clinical Trial Registry https://www.chictr.org.cn, ChiCTR2400083156.