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Randomized Controlled Trial
. 2025 Mar 5;25(1):148.
doi: 10.1186/s12877-025-05787-y.

Effect of intravenous esketamine on postoperative sleep disturbance, anxiety, and depression in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial

Haijin Wang #  1 , Lan Wang #  1 , Jing Gao  2 , Fengqi Zhou  3
Affiliations
Randomized Controlled Trial

Effect of intravenous esketamine on postoperative sleep disturbance, anxiety, and depression in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial

Haijin Wang et al. BMC Geriatr. .

Abstract

Background: The population of elderly individuals undergoing surgical procedures is increasing, necessitating effective postoperative management strategies. Postoperative sleep disturbance, anxiety, and depression are significant contributors to overall recovery in this demographic, especially following laparoscopic abdominal surgery.

Methods: This study included 200 records of elderly patients undergoing laparoscopic abdominal surgery. Patients were divided into an esketamine group, receiving intravenous esketamine, and a control group, receiving normal saline. Parameters such as surgery and anesthesia duration, fluid volume, blood loss, urine output, sleep disturbance, anxiety, depression, pain assessment, and adverse events were compared between the two groups.

Results: The esketamine group had significantly fewer postoperative sleep disturbances, lower anxiety and depression scores on days 1 and 3, and lower Visual Analog Scale (VAS) scores compared to the control group (P < 0.05). They also required less rescue analgesia, used fewer opioids, and consumed fewer non-opioid analgesics (P < 0.05). However, the esketamine group experienced a higher incidence of dissociative symptoms (P < 0.05), while other adverse events were similar between the groups. Overall, esketamine improved pain management and reduced anxiety and depression but increased the risk of dissociative symptoms.

Conclusions: Intravenous esketamine administration in elderly patients undergoing laparoscopic abdominal surgery was associated with reduced postoperative sleep disturbance, lower postoperative pain scores, lower anxiety and depression scores, decreased rescue analgesia requirements, reduced opioid consumption, and a lower use of non-opioid analgesic medications.

Clinical trial number: This clinical study was registered at Chinese Clinical Trial Registry (ChiCTR, ChiCTR2400087795).

Keywords: Elderly patients; Intravenous esketamine; Laparoscopic abdominal surgery; Pain management; Postoperative sleep disturbance.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by the Ethics Committee of Xiangyang No.1 People’s Hospital, Hubei University of Medicine in accordance with regulatory and ethical guidelines. Prior to enrollment, all eligible study subjects provided written informed consent. The procedures were conducted in accordance with the ethical standards set forth by the Committee on Human Experimentation and the Helsinki Declaration of 1975, as revised in 2000. Consent to participate: Informed consent forms were obtained from each participant and his/her guardian. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study design
Fig. 2
Fig. 2
Difference in negative emotion outcomes, pain intensity and frequency between the control group and esketamine group. (A) Comparison of anxiety score between two groups in postoperative day 1 and day 3, *P < 0.05. (B) Comparison of depression score between two groups in postoperative day 1 and day 3, *P < 0.05, **P < 0.01. (C) Comparison of Postoperative 24-hour and 48-hour VAS score between two groups, **P < 0.01, ***P < 0.001. (D) Comparison of postoperative opioid consumption used between two groups, ***P < 0.001. (E) Rescue analgesia rate in two groups, orange area was the number of patients who required postoperative rescue analgesia. (F) Postoperative non-opioid analgesic using rate in two groups, orange area was the number of patients who used non-opioid analgesic
See this image and copyright information in PMC

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