Impact of Combining Esketamine With Erector Spinae Plane Block on Opioid Consumption, Inflammatory Stress, and Cognitive Function After Thoracoscopic Surgery

<b>Aims/Background</b> Esketamine exhibits strong sedative and analgesic effects. Similarly, erector spinae plane block (ESPB) blocks somatic and visceral nerves and is commonly used for pain relief in thoracic surgery. Therefore, this study aims to investigate the impacts of combining esketamine with ESPB on opioid consumption, inflammatory stress, and cognitive function after thoracoscopic surgery. <b>Methods</b> This retrospective study collected clinical data from 114 patients who underwent thoracoscopic surgery at Jinhua Municipal Central Hospital, between January 2022 and January 2024. Based on anesthesia approaches, patients were divided into the ESPB (n = 62) and esketamine + ESPB groups (n = 52). Several variables, such as perioperative indicators, postoperative recovery, inflammatory stress, and cognitive function were compared between the two groups. <b>Results</b> In both groups, the Numeric Rating Scale (NRS) score increased at 6 h postoperatively compared to at 1h, and gradually decreased at 12 h, 24 h, and 48 h (<i>p</i> < 0.05). Compared to the ESPB group, the NRS score was significantly decreased in the esketamine + ESPB group at 6 h, 12 h, 24 h, and 48 h after surgery (<i>p</i> < 0.001). The oxycodone consumption was significantly lower in the esketamine + ESPB group at 24 h and 48 h post-surgery than in the ESPB group (<i>p</i> < 0.001). Furthermore, the incidence of adverse reactions was 30.6% (19/62) in the ESPB group and 34.6% (18/52) in the esketamine + ESPB group, with the difference being statistically insignificant (<i>p</i> = 0.652). Compared to the ESPB group, the white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, and tumor necrosis factor (TNF)-α levels were significantly decreased in the Esketamine + ESPB group at day 3 after surgery (<i>p</i> < 0.001). Compared to the ESPB group, the Montreal Cognitive Assessment Scale (MoCA) score was substantially elevated in the esketamine + ESPB group at days 1 and 3 after surgery (<i>p</i> < 0.001, <i>p</i> = 0.001). <b>Conclusion</b> The combination of esketamine and ESPB effectively alleviated postoperative pain and reduced opioid consumption after thoracoscopic surgery. Furthermore, the combined approach significantly improved postoperative inflammatory stress and cognitive impairment compared to the use of ESPB alone without increasing adverse reactions.