Effects of sub-anesthetic doses of esketamine on postoperative sleep disturbance and pain in patients undergoing lumbar interbody fusion - A randomized, double-blind, placebo-controlled, two-center trial

Abstract

Background: Postoperative sleep disturbance (PSD) is a common postoperative complication that significantly impacts patients' recovery, particularly after lumbar surgery.

Methods: This two-center, double-blind, placebo-controlled randomized trial was conducted between June 6, 2024, and November 26, 2024, in two hospitals in China. A total of 80 patients participated in this study and were randomly assigned to the esketamine group (n = 40) or the placebo group (n = 40). Patients in the esketamine group received 0.2 mg kg^-¹ of esketamine for anesthesia induction, with a maintenance rate of 0.02 mg kg^-¹·h^-¹, followed by 1 mg kg^-¹ of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the placebo group of patients. The primary outcome of this study was the incidence of PSD on postoperative day (POD) 1. PSD was defined as a Numeric Rating Scale-sleep score of 6 or higher or an Athens Insomnia Scale score of 6 points or higher.

Results: The incidence of PSD on POD 1 was significantly lower in the esketamine group compared to the placebo group (33% vs. 67%; P = 0.003). Notably, the Visual Analog Scale (VAS)-pain score at rest was lower in the esketamine group compared to the placebo group at 1, 3, and 6 h after surgery (P < 0.05); moreover, the VAS-pain score with movement was also lower in the esketamine group than the placebo group at 1, 3, 6, and 24 h after surgery (P < 0.05). Furthermore, the Quality of Recovery-15 (QoR-15) scores were significantly higher in the esketamine group than in the placebo group on POD 1 (107 [103- 117] vs. 99 [96-108]; P = 0.005) and POD 3 (130 [122-136] vs. 124 [117-127]; P = 0.003).

Conclusion: Sub-anesthetic doses of esketamine can reduce the incidence of PSD on POD1, reduce postoperative pain, and improve QoR.

Clinical trial registration: Chinese Clinical Trial Registry https://www.chictr.org.cn, ChiCTR2400083156.

Keywords: esketamine; multimodal analgesia; postoperative sleep disturbance; spine.