Effect of opioid sparing anesthesia with esketamine on PONV in laparoscopic sleeve gastrectomy randomized trial

Abstract

Postoperative nausea and vomiting (PONV) remains highly prevalent in laparoscopic sleeve gastrectomy (LSG), with intraoperative opioid use being a key contributing factor. We conducted a prospective, double-blind, randomized trial to compare esketamine-based opioid-sparing anesthesia (OSA) to opioid-based anesthesia in adults undergoing LSG, The primary outcome was the incidence of PONV within 48 h postoperatively. OSA was associated with a significant reduction in the overall incidence of PONV within 48 h, while maintaining comparable analgesic efficacy or postoperative recovery. Additionally, OSA showed clinically significant reductions in both PONV incidence within the first 24 h and severity specifically during the 6-24-h period. Results suggest that OSA is an effective strategy for mitigating PONV following LSG.

Keywords: Anesthesiology; Medicine; health sciences; medical specialty; surgery.

Graphical abstract

Figure 1

Trial flow diagram OSA, opioid-sparing anesthesia. Control group, opioid-based anesthesia.

Figure 2

Primary outcome, PONV severity grading within 24 h after surgery (A) Incidence of PONV during 0–6 h, 6–24 h, and 24–48 h after surgery. (B) PONV severity grading during 0–6 h after surgery. (C) PONV severity grading during 6–24 h after surgery. OSA, opioid-sparing anesthesia. PONV, postoperative nausea and vomiting. Control group, opioid-based anesthesia. ∗p < 0.05 by x² test. Each cohort comprised 34 participants: OSA group (n = 34) and control group (n = 34).