Moderate-to-severe acute postsurgical pain after spinal surgery can slow recovery. A combination of esketamine and pregabalin reduced the incidence of such pain from 60.5% to 27.3% in the first 48 hours after surgery, based on a randomized trial of 90 patients undergoing resection of spinal neoplasms. The odds ratio was 0.25, indicating a substantial benefit. However, mild dissociative symptoms occurred in 18.2% of the combination group versus none in the control group, suggesting the analgesic strategy carries this risk.
Among patients undergoing major surgery who had moderate-to-severe depressive symptoms before the operation, a single intraoperative dose of esketamine led to a higher rate of symptom remission three days after surgery compared with a placebo. In a randomized, double-blind trial of 435 patients, 28.3% in the esketamine group achieved remission versus 11.3% in the placebo group. Acute pain rates did not differ between groups. Esketamine treatment requires monitoring for possible dissociative side effects, and its clinical use for depressive symptoms should weigh benefits against risks.