An Exploratory Study of Esketamine in Patients After Thoracoscopic Surgery
Condition: Esketamine; Thoracoscopic Surgery
Study type: Interventional
Phase: Phase 4

Summary: 
      Thoracic surgery can produce severe postoperative acute pain, which can easily lead to cough
      weakness, atelectasis, respiratory restriction, pneumonia, hypoxemia, secretion retention,
      respiratory failure and other adverse events. Esketamine can reduce the demand of analgesic
      opioids, reduce the respiratory depression caused by opioids, improve ventilation,
      significantly reduce postoperative pain and prolong the analgesic time after thoracic
      surgery. Therefore, the application of esketamine in postoperative analgesia of patients
      undergoing thoracoscopic surgery may help to improve the respiratory function of clinical
      patients and further improve the postoperative analgesia effect, so as to achieve the purpose
      of accelerating the surgical rehabilitation of patients undergoing thoracoscopic surgery.
      Esketamine is rarely used in perioperative period in China, and the development of its safe
      and reasonable application methods and potential role in perioperative anesthesia needs
      further research and verification. Generally speaking, at present, there is still a lack of
      evaluation of ketamine in improving respiratory function, pain, anxiety and depression after
      thoracoscopic surgery, and there is no direct clinical evidence.

      At present, sufentanil is the most commonly used drug for postoperative analgesia in patients
      undergoing clinical surgery. As a strong opioid, although sufentanil can provide good
      analgesic effect, the respiratory depression caused by sufentanil is not conducive to the
      recovery of postoperative lung function in patients undergoing thoracic surgery. The action
      sites of esketamine include N- methyl-aspartic acid (NMDA) receptor, opioid receptor,
      monoamine receptor, M cholinergic receptor, sodium channel, calcium channel, etc., which can
      relieve respiratory depression caused by opioids, stimulate respiration, relax airway smooth
      muscle, prevent hyperalgesia caused by opioids, reduce the dosage of postoperative analgesics
      and prolong the duration of postoperative analgesia. Therefore, esketamine is likely to
      improve postoperative respiratory function of patients after thoracoscopic surgery and play a
      good role. To sum up, this study is intended to include patients undergoing elective
      thoracoscopic surgery. Through a prospective randomized controlled double-blind clinical
      trial, different analgesic drugs of intravenous patient-controlled analgesia and simple
      conventional opioid analgesic sufentanil are used as the control. Combined with the
      investigation of preoperative and postoperative tidal volume, oxygenation index,
      postoperative pain and postoperative recovery outcome, the effects of esketamine on
      postoperative respiratory function, postoperative pain and overall rehabilitation of these
      patients are compared, so as to provide direct clinical evidence for improving postoperative
      lung function of patients undergoing elective thoracoscopic surgery, and at the same time,
      provide a choice for thoracoscopic surgery.

      To explore the effect of esketamine on improving postoperative respiratory function, pain,
      depression and anxiety and overall rehabilitation of patients undergoing thoracoscopic
      surgery. Compound esketamine is used for postoperative analgesia, thus providing direct
      clinical evidence for improving postoperative pulmonary function of patients undergoing
      elective thoracoscopic surgery, and providing reference for improving postoperative pain,
      anxiety and depression of patients undergoing elective thoracoscopic surgery.
    


Intervention name(s): Esketamine
Intervention type(s): Drug
Intervention description(s): Self-controlled intravenous analgesia pump was used for continuous injection, and it was prepared according to sufentanil 1.5ug/ml+ esketamine 0.75ug/ml+16mg ondansetron. After the operation, the analgesic pump was connected, and sufentanil 0.1ug/kg/h+ esketamine 0.05mg/kg/h was pumped continuously for 24 hours. The continuous infusion of analgesia pump is (kg body weight/15) ml/h. (e.g. 60kg, pump speed 4ml/h, total amount 96ml).
Intervention MeSH terms: Esketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment