Ye Zhang,1,2 Shuqin Li,1,2 Cheng Wu,1,2 Liuyi Song,1,2 Li Hu,1,2 Jian Lu1,2 

1Department of Anesthesiology, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing City, People’s Republic of China; 2Jiaxing Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, People’s Republic of China

Correspondence: Jian Lu, Email ljp200681@163.com

Background: To evaluate the effect of perioperative subanesthetic dose of esketamine on the postoperative recovery quality in patients undergoing laparoscopic gastrointestinal surgery.
Methods: A total of 144 patients undergoing elective surgery for gastrointestinal tumors were selected and randomly assigned to either the esketamine group or the control group, with 72 patients in each group. Based on the standardized general anesthesia protocols, the esketamine group received an intravenous injection of esketamine at a dose of 0.2 mg/kg during the induction of anesthesia and an additional 0.2 mg/kg 30 minutes before the end of the surgery. Patient-controlled intravenous analgesia (PCIA) was administered for 48 hours, the esketamine group was treated with sufentanil (0.04 μg/kg/h) combined with esketamine (0.02 mg/kg/h) and sufentanil (0.04 μg/kg/h) was used as the control group. The scores of 40-items Quality of Recovery Scale (QoR-40) were recorded one day before surgery, one day after surgery, three days after surgery, and five days after surgery. Numerical Rating Scale (NRS) pain scores were recorded at postoperative intervals of 6 hours, 24 hours, 36 hours, and 48 hours. Levels of interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and brain-derived neurotrophic factor (BDNF) in venous blood were analyzed prior to entering the operating room, upon arrival at the recovery room, and on the second postoperative day.
Results: A total of 140 patients completed this study. Compared to the control group, the QoR-40 scores in the esketamine group were significantly higher at 1, 3, and 5 days post-surgery (Z = − 10.080, Z = − 8.178, Z = − 4.139, P < 0.05). In addition, the resting NRS scores were significantly lower at 6 hours, 24 hours, 36 hours, and 48 hours post-surgery in the esketamine group (Z=− 6.322, Z=− 5.736, Z=− 6.563, Z=− 5.920, P < 0.05).
Conclusion: This study found that the perioperative use of subanesthetic esketamine improved early postoperative recovery quality and reduced postoperative pain levels in patients undergoing laparoscopic gastrointestinal surgery.

Keywords: esketamine, recovery quality, laparoscopic gastrointestinal surgery, pain, anesthesia