Effect of continuous subanesthetic esketamine infusion on postoperative fatigue in patients undergoing laparoscopic radical resection for colorectal cancer: a randomized controlled study

Abstract

This study aimed to examine the effect of subanesthetic esketamine on postoperative fatigue in patients who underwent laparoscopic colorectal surgery. A total of 62 patients, including 32 in the esketamine group and 30 in the control group, were analysed in this study. Compared with the control group, the patients in the esketamine group had reduced Identity-Consequence Fatigue Scale (ICFS) on the 3rd and 7th days after surgery (P<0.05). There were also significant differences in the Positive and Negative Affect Schedule (PANAS) scale between the two groups. The positive affect scale was higher on postoperative day 3 (POD3), while the negative affect scale was lower on POD3 and postoperative day 7 (POD7) in the esketamine group than in the control group. However, the scores of postoperative hand grip strength, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Numeric Rating Scale (NRS) and Athens Insomnia Scale (AIS) were not significantly different between the two groups. Furthermore, mediation analysis showed that esketamine played an anti-fatigue role through improving emotional heath. Importantly, no adverse reactions occurred at this dosage of esketamine. Finally, our study suggested that subanesthetic esketamine improved postoperative fatigue, stabilized postoperative mood, reduced intraoperative remifentanil consumption, and promoted postoperative intestinal function recovery without increasing adverse reactions.

Keywords: Esketamine; emotional functioning; laparoscopic colorectal surgery; postoperative fatigue.

Figure 1

Study Flowchart. Sixty-four participants were randomized. Two patients were excluded from the placebo group, and none were excluded from the esketamine group.

Figure 2

ICFS score at different time points. ICFS, Identity-Consequence Fatigue Scale; PRE, Preoperative; POD, Postoperative Day. A repeated-measures ANOVA followed by Bonferroni’s post hoc test was used. The horizontal axis is the time, and the vertical axis is the ICFS score. The data are expressed as the mean ± SD. *Compared with the control group, P<0.05.