Effects of S-ketamine added to patient-controlled analgesia on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized double-blinded controlled trial

Perioperative esketamine combined with butorphanol versus butorphanol alone for pain management following video-assisted lobectomy: a randomized controlled trial

BACKGROUND

The analgesic efficacy of esketamine combined with butorphanol in thoracoscopic surgery remains unclear.

AIM

This study explored the effects of perioperative esketamine combined with butorphanol versus butorphanol alone on acute and chronic postoperative pain in patients who underwent video-assisted lobectomy.

METHOD

A total of 181 patients were enrolled, with 90 in the esketamine-butorphanol group (Group BK) receiving intraoperative esketamine infusion and postoperative patient-controlled intravenous analgesia (PCIA) (esketamine 1.5 mg/kg, butorphanol 0.15 mg/kg, azasetron 20 mg). The remaining 91 patients in the butorphanol group (Group B) received normal saline and PCIA with butorphanol (0.15 mg/kg) and azasetron (20 mg). Primary endpoints included Visual Analog Scale (VAS) scores in the first week and chronic pain incidence at three months. Secondary endpoints included intraoperative vital signs, morphine consumption, postoperative adverse events, and 15-item Quality of Recovery-15 (QoR-15) scores.

RESULTS

Group BK demonstrated significantly lower VAS scores within 48 h at rest and within 24 h during coughing postoperatively (P < 0.001). However, no significant differences were observed in VAS scores [(Group B, 5 (0-12)) vs. (Group BK, 5 (0-9)), P = 0.517] or chronic pain incidence [(Group B, 34.1%) vs. (Group BK, 23.3%), P = 0.111] between the two groups at the three-month follow-up. Patients in Group BK exhibited improved postoperative stability of vital signs and higher QoR-15 scores.

CONCLUSION

Perioperative administration of esketamine significantly mitigates acute postoperative pain and enhances recovery quality in patients undergoing video-assisted lung resection.

TRIAL REGISTRATION

This trial protocol is registered with ClinicalTrials.gov (NCT06398834, date: 2024-05-01).

Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.

METHODS

A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.

RESULTS

A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD -0.65, p = 0.04) and 48 h (MD -0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.

CONCLUSIONS

Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine's potential benefits for chronic pain management.

REGISTRATION

PROSPERO (CRD42024527858).

Opioid-free strategies for patient-controlled intravenous postoperative analgesia: a review of recent studies

Postoperative pain management has consistently been a critical topic in the medical field, with patient-controlled intravenous analgesia (PCIA) being one of the most commonly utilized methods for postoperative analgesia. Currently, opioids remain the primary choice for PCIA in clinical practice. However, in recent years, an increasing number of studies have explored analgesic strategies aimed at reducing or eliminating the use of opioids in PCIA to mitigate the associated side effects and dependence. This article systematically reviews the progress of research on opioid-free analgesic strategies in PCIA through a comprehensive analysis of relevant literature.

Influence of Intravenous Magnesium Sulfate Infusion on the Subjective Postoperative Quality of Recovery: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis investigated the effects of intravenous magnesium sulfate on the postoperative recovery quality, as assessed using the Quality of Recovery (QoR) questionnaire, in adult surgical patients. Seven randomized controlled trials involving 622 patients were included. Compared with the placebo, magnesium sulfate significantly improved the global QoR score on postoperative day 1 (standardized mean difference [SMD]: 1.24; 95% confidence interval: 0.70-1.78; p < 0.00001). It also enhanced specific QoR dimensions, with substantial effects on pain (SMD: 1, p < 0.00001) and physical comfort (SMD: 0.85, p < 0.0001), a moderate effect on emotional state (SMD: 0.65, p = 0.002), and small improvements in physical independence (SMD: 0.43, p < 0.00001) and psychological support (SMD: 0.37, p < 0.0001). In addition, magnesium sulfate reduced the intraoperative opioid consumption (SMD: -0.66, p < 0.0001), postoperative pain severity, and the incidence of postoperative nausea and vomiting (risk ratio: 0.48, p = 0.008). The extubation times were unaffected, whereas the post-anesthesia care unit stay was slightly prolonged. These findings highlight the potential of magnesium sulfate as a valuable adjunct for multimodal analgesia and enhanced recovery. Future studies should aim to elucidate the optimal dosing strategies, timing of administration, and specific surgical populations that may derive maximum benefits.

Efficacy and safety of perioperative application of esketamine on postoperative depression: a meta-analysis of randomized controlled studies

BACKGROUND

Postoperative depression has a profound impact on patients' postoperative rehabilitation and overall quality of life. Preventing postoperative depression is of significant value because conventional antidepressants have a slow onset of action. Esketamine showed prompt and sustained antidepressant efficacy. Nevertheless, the safety and effectiveness of perioperative esketamine in preventing postoperative depression are still unknown. The purpose of this meta-analysis was to assess the safety and effectiveness of perioperative intravenous esketamine in relation to its ability to prevent postoperative depression.

MATERIALS AND METHODS

Randomized controlled trials were searched in the following databases: Web of Science, Cochrane Central Registry of Controlled Trials, PubMed, and Embase. The primary outcome assessed is the postoperative depression scores. Postoperative pain ratings and adverse effects constituted secondary outcomes. Subgroup analyses were carried out on the basis of multiple variables, including the absence or presence of preoperative depression, the mode of esketamine administration, the dosage of esketamine, and the type of anesthesia.

RESULTS

A total of 16 studies encompassed 1161 patients who received esketamine intervention, whereas 1106 patients served as controls. Esketamine was efficacious in reducing postoperative depression scores when administered perioperatively, and the esketamine group maintained a lower postoperative depression score than the control group more than four weeks after surgery. Esketamine effectively alleviated postoperative pain scores without increasing the occurrence of postoperative nausea and vomiting, dizziness, drowsiness, nightmares, and dissociation.

CONCLUSION

The administration of esketamine during the perioperative has the potential to decrease postoperative depression and pain scores without increasing the incidence of adverse effects.

Efficacy and safety of esketamine for perioperative depression in patients undergoing elective surgery: A meta-analysis of randomized controlled trials

BACKGROUND

Depression is a prevalent mood disorder during the perioperative period, with both preoperative concurrent depression and new-onset postoperative depression impacting postoperative recovery. Recent studies have indicated that the dissociative anesthetic esketamine may alleviate perioperative depressive symptoms.

OBJECTIVE

This meta-analysis aimed to assess the efficacy and safety of esketamine in treating perioperative depression.

METHODS

We selected randomized controlled trials comparing esketamine to placebo in terms of postoperative depressive symptoms. The primary outcome was postoperative depression scores, with secondary outcomes including the prevalence of postoperative depression, pain scores using the Visual Analogue Scale or Numeric Rating Scale, and incidences of adverse reactions such as nausea/vomiting, dizziness, dreams/nightmares, hallucinations.

RESULTS

We enrolled a total of 17 studies involving 2462 patients. The esketamine group demonstrated a significant reduction in postoperative depression scores within one week after surgery (SMD -0.47, 95% CI (-0.66, -0.27), P < 0.001) and over the long term (SMD -0.44, 95% CI (-0.79, -0.09), P = 0.01). Furthermore, esketamine significantly decreased the prevalence of postoperative depression both within one week (RR 0.46, 95% CI (0.33, 0.63), P < 0.001) and over the long term (RR 0.50, 95% CI (0.36, 0.70), P < 0.001). Additionally, esketamine effectively relieved pain on the first postoperative day compared to control. However, it also increased the risks of dizziness and hallucinations for a short time.

CONCLUSION

This meta-analysis suggests that the intraoperative or postoperative application of esketamine could be a potentially effective treatment for perioperative depression, although the increased risk of adverse reactions should be considered.