Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study

Abstract

Background Opioid-reduced anesthesia may accelerate postoperative rehabilitation by reducing opioid-related side effects. The objective was to investigate the feasibility of opioid-reduced general anesthesia based on esketamine and to observe postoperative nausea and vomiting (PONV), postoperative pain, hemodynamics and other adverse reactions in gynecological day surgery compared with the traditional opioid-based anesthesia program. Method This study was conducted as a prospective parallel-group randomized controlled trial. A total of 141 adult women undergoing gynecological day surgery were included. Patients were randomly assigned to receive traditional opioid-based anesthesia (Group C) with alfentanil, or opioid-reduced anesthesia (a moderate-opioid group (Group MO) and low-opioid group (Group LO) with esketamine and alfentanil). For anesthesia induction, the three groups received 20, 20, 10 μg/kg alfentanil respectively and Group LO received an additional 0.2 mg/kg esketamine. For maintenance of anesthesia, the patients in Group C received 40 μg/kg/h alfentanil, and those in Group MO and Group LO received 0.5 mg/kg/h esketamine. Results Patients in the three groups had comparable clinical and surgical data. A total of 33.3% of patients in Group C, 18.4% of patients in Group MO and 43.2% of patients in Group LO met the primary endpoint (p = 0.033), and the incidence of nausea within 24 hours after surgery in Group MO was lower than in Group LO (p < 0.05). The extubation time, median length of stay in the hospital after surgery and visual analog scale (VAS) of postoperative pain were equivalent in the three groups. The frequencies of adverse hemodynamic events in the MO 1(0, 2) and LO 0(0, 1) groups were significantly decreased (p < 0.05). Compared with Group C, the median length of stay in the postanesthesia care unit (PACU) in Group LO was increased, 60.0 (36.25, 88.75) vs. 42.5 (25, 73.75) minutes (p < 0.05). Conclusions Opioid-reduced anesthesia based on esketamine is feasible and provides effective analgesia for patients. Esketamine provided a positive analgesic effect and the opioid-reduced groups showed more stable hemodynamics. However, less or no use of opioids did not result in a more comfortable prognosis. Trial registration This study was registered at Chictr.org.cn (NO. ChiCTR2100053153); November 13, 2021.

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

“… 15 We recorded hemodynamic characteristics and found no significant difference between the groups before operation. However, HR, SBP, and DBP decreased immediately after anesthesia induction in group C. With the addition of esketamine, the decreasing trends mentioned above disappeared, and the patients exhibited more stable vital signs, which is similar to the results of previous studies, 17 and the sympathetic excitatory effect of esketamine may be the reason for the stable hemodynamic.…”

The Relationship Between Perioperative Use of Esketamine and Postpartum Depression Risk: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“… 25 , 26 Esketamine is a strong analgesic that has been used to provide assistant analgesia in intraoperative and postoperative practice, and is related to a reduced consumption of opioids. 27 , 28 Moreover, esketamine can be safely applied to caesarean section, since it does not impact on newborns. 29 , 30 Owing to its antidepressant effects, esketamine has been well recognized, especially for the treatment of resistant depression.…”

Effects of adding low-dose esketamine to sufentanil and propofol sedation during cervical conization: a prospective, single-center, randomized controlled trial

“…Eberl S et al [] assessed the effectiveness of esketamine versus alfentanil as an adjunct to propofol TCI for deep sedation during ambulant endoscopic retrograde cholangiopancreatography, and found that low-dose esketamine reduces the total amount of propofol necessary for sedation, without affecting recovery time and respiratory or cardiovascular adverse events compared to alfentanil. Another study by Zhu T et al [14] found that administering an additional 0.2mg/kg loading dose followed by a 0.5mg/kg/h infusion of esketamine provided more stable hemodynamics in opioid-reduced general anesthesia. The current study also showed a lower incidence of hypotension and a relative higher MAP during the procedure with a combination of esketamine and sufentanil sedation.…”