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Randomized Controlled Trial
. 2025 Jan 1;111(1):677-685.
doi: 10.1097/JS9.0000000000002060.

Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial

Jing-Hui Hu  1   2 , Zhang-Zhen Zhong  1   3 , Hai-Jing Shi  1   2 , Jie Wang  3 , Shaomu Chen  4 , Xi-Sheng Shan  1   2 , Hua-Yue Liu  1   2 , Hong Liu  5 , Lingzhong Meng  6 , Fu-Hai Ji  1   2 , Ke Peng  1   2
Affiliations
Randomized Controlled Trial

Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial

Jing-Hui Hu et al. Int J Surg. .

Abstract

Background: Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection.

Materials and methods: This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 ml. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0.

Results: The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR ( P =0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI: 4.0-8.1; P <0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI: 0.2-4.9; P =0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0).

Conclusions: For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Erector spinae plane block and intercostal nerve block. (A) Ultrasound image of erector spinae plane block. (B) Thoracoscopic visualization of intercostal nerve block. ESM, erector spinae muscle; IS, intercostal space; LA, local anesthetic; RM, rhomboid muscle; TM, trapezius muscle.
Figure 2
Figure 2
CONSORT flow diagram of patients in this 2×2 factorial trial.
Figure 3
Figure 3
QoR-15 scores at 24 h postoperatively. (A) Esketamine vs placebo. (B) ESPB vs ICNB. (C) Effect size of esketamine vs placebo and ESPB vs ICNB. ESPB, erector spinae plane block; ICNB, intercostal nerve block; QoR-15, Quality of Recovery-15.
See this image and copyright information in PMC

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