Effects of Different Doses of Esketamine on Pain Sensitivity of Patients Undergoing Thyroidectomy: A Randomized Controlled Trial

Abstract

Introduction Several factors may lead to increased postoperative pain sensitivity, of which remifentanil-induced hyperalgesia (RIH) is one of the main factors. High-dose remifentanil exposure during anesthesia may induce RIH. Esketamine may prevent RIH by antagonizing N -methyl- d -aspartate (NMDA) receptors, thereby reducing the postoperative pain sensitivity. This study examined the effects of different esketamine doses on pain sensitivity in patients undergoing thyroidectomy and determined the optimal dose. Methods This study included 117 patients who received elective thyroidectomy. They were randomized into four groups: saline group (group C), esketamine 0.2 mg·kg −1 group (group RK1), esketamine 0.4 mg·kg −1 group (group RK2), and esketamine 0.6 mg·kg −1 group (group RK3). Five minutes before anesthesia induction, the same volume of study drugs were injected respectively in groups C, RK1, RK2, and RK3. Remifentanil was pumped at the same rate of 0.3 µg·kg −1 ·min −1 during surgery to ensure uniformity. This study’s primary outcomes were the mechanical pain thresholds measured before surgery, as well as at 30 min, 6 h, 24 h, and 48 h after surgery. Hyperalgesia, rescue analgesia, numerical rating scale (NRS) score, and adverse reactions were recorded. Results Compared with baseline, the mechanical pain threshold was significantly decreased in group C [(94.67 ± 22.85) versus (112.00 ± 36.62) versus (161.33 ± 53.28) g, P < 0.001 at 30 min, P < 0.001 at 6 h] and group RK1 [(102.86 ± 24.17) versus (114.29 ± 41.05) versus (160.00 ± 54.98) g, P < 0.001 at 30 min, P < 0.001 at 6 h] around the surgical incision, and in group C [(112.00 ± 31.78) versus (170.67 ± 56.26) g, P < 0.001 at 30 min, (118.67 ± 34.42) versus (170.67 ± 56.26) g, P = 0.001 at 6 h] and group RK1 [(114.29 ± 45.17) versus (175.71 ± 54.80) g, P = 0.001 at 30 min, (121.43 ± 38.46) versus (175.71 ± 54.80) g, P = 0.002 at 6 h] on the forearm at 30 min and 6 h after surgery; compared with group C, the mechanical pain threshold was higher in group RK2 [(142.76 ± 50.06) versus (94.67 ± 22.85) g, P < 0.001 at 30 min, (145.52 ± 49.83) versus (112.00 ± 36.62) g, P < 0.001 at 6 h] and group RK3 [(140.00 ± 40.68) versus (94.67 ± 22.85) g, P < 0.001 at 30 min, (150.67 ± 56.50) versus (112.00 ± 36.62) g, P = 0.010 at 6 h] around the surgical incision, and in group RK2 [(149.66 ± 39.50) versus (112.00 ± 31.78) g, P = 0.006 at 30 min, (156.55 ± 47.23) versus...

Development of a nomogram for predicting acute pain among patients after abdominal surgery: A prospective observational study

“…We identified higher use doses of remifentanil as a risk factor for more intense post-operative pain, which aligns with previous research (Chen et al, 2023). Reasons may be that its use was not only associated with longer operative time but also with a rise in pain sensitivity following the use of remifentanil during surgery (Ren et al, 2023). Drainage tubes are routinely placed in most procedures to prevent fluid collection and timely find complications after surgery (Abu et al, 2022).…”

Effect of Continuous Infusion of Different Doses of Esketamine on the Bispectral Index During Sevoflurane Anesthesia: A Randomized Controlled Trial

“…6,9 Esketamine, the dextro-isomer of ketamine, has approximately twice the affinity for NMDAR as ketamine and is characterized by quicker onset, faster elimination, fewer adverse effects, and better sedative and analgesic potency. 10,11 Previous clinical studies have demonstrated that intraoperative esketamine application decreases early pain scores, [12][13][14] spares opioids, 15,16 reduces hyperalgesia, 17,18 and promotes postoperative recovery in various ways. [19][20][21][22][23][24] Quantitative studies on the change in the BIS caused by continuous esketamine infusion during general anesthesia are currently lacking.…”

Intravenous esketamine as an adjuvant for sedation/analgesia outside the operating room: a systematic review and meta-analysis

“…Esketamine and ketamine can deliver analgosedation action, but some drawbacks such as the induction of frequent vomiting and clustered psychiatric symptoms limit their single administration ( Nakao et al, 2003 ). Low-dose esketamine as an adjuvant has been shown to have several benefits for sedation or anesthesia, including stabilizing hemodynamics and respiratory function, decreasing propofol requirements, or reducing postoperative pain sensitivity ( Huang et al, 2023 ; Ren et al, 2023 ).…”