Effects of intraoperative intravenous esketamine infusion on the quality of recovery and pain after laparoscopic cholecystectomy
Authors: Li Lifang , Cheng Zhangqin , Wang Liuyi , Zhang Yuhan , Qi Yu , Zhou Meiyan , Wang Liwei 
Published: January 2023

Abstract
Background: Laparoscopic cholecystectomy (LC) is the most common intra-abdominal surgical procedure globally, which frequently leads to substantial postoperative pain. Opioids play a major role in pain management previously. Some studies found that esketamine could reduce pain and opioid consumption. However, the relationship between esketamine and the postoperative quality of recovery and pain is uncertain undergoing LC. Thestudy aimed to evaluate the effects of intraoperative intravenous esketamine infusion on the quality of recovery (QoR) and pain after laparoscopic cholecystectomy (LC).
Patients and methods: A total of 152 patients were randomly divided into the control (0.9% saline), 0.2 mg (esketamine bolus 0.2 mg/kg, followed by 0.2 mg/kg/h) and 0.3 mg (esketamine bolus 0.3 mg/kg, followed by 0.3 mg/kg/h) groups. A bolus of 0.9% saline/esketamine was administered before endotracheal intubation, followed by continuous infusion until gallbladder removal. The primary outcomes were 40-item QoR (QoR-40) score on postoperative day 1 (POD-1) and pain (Numerical Rating Scale, NRS) score during rest and coughing at different time points. The secondary outcomes were hemodynamic parameters, propofol and remifentanil consumption, 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride, postoperative parameters, and adverse events.
Results: The global QoR-40 score on POD-1 was lower in the control group than in the 0.2 and 0.3 mg groups. The NRS score during rest and coughing was lower in the 0.2 and 0.3 mg groups than in the control group at alltime points. Hemodynamic parameters were more stable in the esketamine groups. Propofol and remifentanil consumption was higher in the control group than in the esketamine groups. The 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride was lower in the esketamine groups. The extubation time was longer in the 0.3 mg group than in the control and 0.2 mg groups. The control group had more patients with oxygen saturation (SpO2) <95%. The incidence of postoperative vertigo, nystagmus and diplopia was higher in the 0.3 mg group than in the control and 0.2mg groups.
Conclusions: Intravenous esketamine infusion improved the QoR on POD-1 after LC. It provided a good analgesic effect, reduced the 48-h cumulative consumption of flurbiprofen axetil and tropisetron hydrochloride, and resulted in stable hemodynamic parameters. However, a higher esketamine dose prolonged the extubation time and increased the incidence of adverse events.
Trial registration:
This study was approved by the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20211209-051) and registered at ClinicalTrials.gov (19/12/2021, ChiCTR2100054508). This randomized triple-blind placebo-controlled trial was performed from December 2021 to August 2022. Written informed consent was obtained from all patients. The study was terminated after follow-up completion of the last study participant.