Effect of low-dose esketamine on postoperative quality of recovery in total laparoscopic hysterectomy: a randomized controlled trial.

In patients undergoing total laparoscopic hysterectomy, a single low dose of esketamine (0.25 mg/kg) given at anesthesia induction did not improve overall quality of recovery as measured by the QoR-40 questionnaire compared to saline. However, esketamine reduced intraoperative opioid use, stabilized blood pressure and heart rate, shortened time to extubation and recovery room stay, and lowered postoperative pain scores, inflammation, and sleep disturbance without causing adverse effects. Higher education level was associated with better recovery.

Study at a glance

Abstract

To investigate the effect of intraoperative low-dose esketamine administered at anesthesia induction on postoperative quality of recovery in total laparoscopic hysterectomy. One-hundred six female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into saline group (group P) and esketamine group (group S). Group P received induction with normal saline, propofol, sufentanil, midazolam, and rocuronium, while group S received induction with low-dose esketamine (0.25 mg/kg), propofol, sufentanil, midazolam, and rocuronium. Both groups were maintained with intravenous infusions of propofol and remifentanil. The quality of recovery (QoR-40), Numerical Rating Scale (NRS), and Pittsburgh Sleep Index (PSQI) scores were assessed at 8, 24, 48, and 72 h, 7 days, and 30-day post-surgery. Hamilton Depression Scale (HAMD) scores were evaluated at 72 h, 7 days, and 30-day post-surgery. Intraoperative hemodynamics, remifentanil consumption, inflammatory reactions, and adverse reactions were also documented. Both groups had similar QoR-40 scores at each time point (P > 0.05). Patients in group S had less intraoperative remifentanil use (P < 0.001), less consumption of phenylephrine (P = 0.005), fewer episodes of hypotension (P < 0.001), and shorter extubation time and stay in postanesthesia care unit (PACU) (P < 0.001). The NRS scores after extubation (P = 0.007), 8 h (P = 0.027) and 48 h (P = 0.016) after surgery, and the postoperative NLR (P = 0.003) and postoperative 24-h PSQI score (P = 0.024) were significantly lower in group S. The mean blood pressure (MBP) was higher at 10 min after incubation (T3) (P < 0.001). The heart rate (HR) was faster at 3 min (T1) (P = 0.005), 10 min (T3) (P = 0.023), and 30 min (T4) (P = 0.014) after incubation and complete end of surgery (T5) (P = 0.010) in group S. Multiple linear regression analyses demonstrated that higher education was associated with better recovery (P < 0.05). In patients undergoing total laparoscopic hysterectomy, one injection of low-dose esketamine at anesthesia induction did not affect QoR-40 scores. However, esketamine stabilized intraoperative hemodynamics, decreased intraoperative opioid requirements, and shortened postoperative extubation time and PACU stay. It also alleviated postoperative inflammatory response and pain without causing adverse effects.