Effects of esketamine combined with thoracic paravertebral block on postoperative early sleep in patients undergoing thoracoscopic lobectomy

Objective To observe the effects of continuous intravenous infusion of esketamine combined with thoracic paravertebral nerve block (TPVB) on postoperative early sleep, analgesia, and recovery quality in patients undergoing thoracoscopic lobectomy. Methods A total of 76 patients scheduled for elective thoracoscopic lobectomy at Nanjing First Hospital from January 2023 to January 2024 were randomly divided into two groups: the control group (C group) and the esketamine group (E group), with 38 patients in each group. Patients in the E group received intravenous injection of 0.2 mg/kg esketamine during anesthesia induction, followed by a continuous infusion of 0.1 mg·kg-1·h-1 esketamine until the end of the surgery. Patients in the C group received an equal volume of normal saline. Multichannel〖LM〗 sleep monitoring was conducted on the day before surgery, the first day after surgery, and the third day after surgery to assess patients sleep conditions. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality on the same days. Visual Analog Scale (VAS) scores were recorded at 2, 6, 12, 24, and 48 hours postoperatively, along with patient-controlled intravenous analgesia (PCIA) pressing times and rescue analgesia rates within 48 hours after surgery. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (HADS-A) and depression (HADS-D) scores on one day before surgery, the first and third days after surgery. Recovery quality was assessed using the Quality of Recovery-15 (QoR-15) on the first and third days after surgery, and the time of flatus was recorded. Results Compared with the C group, the total sleep time, sleep efficiency index, proportion of rapid eye movement were higher, while PSQI score was lower in the E group on the first and third postoperative days (P<0.05). VAS scores at 24 hours and 48 hours after surgery were significantly lower in the E group than those in the C group (P＜0.05), and the PCIA pressing times at 48 hours postoperatively were significantly lower than those in the E group [(13.8±4.3) times vs (16.2±3.7) times, t=2.556, P=0.013]. Compared with the C group, the HADS-A and HADS-D scores were lower, the QoR-15 scores were higher (P＜0.05) on the first and third days after surgery, and the flatus time occurring significantly earlier [(17.1±2.0) h vs (18.3±2.1) h, t=2.646, P=0.010] in the E group. Conclusion Intraoperative intravenous infusion of esketamine combined with TPVB can improve early postoperative sleep, anxiety, and depression, and promote recovery in patients undergoing thoracoscopic lobectomy to a certain extent.