Effect of Esketamine-Based Opioid-Sparing Anesthesia Protocol on the Quality of Early Recovery After Urological Surgery: A Randomized Clinical Trial

Yu Qi,1,2,&ast; Weihua Li,1,3,&ast; Ying Ren,1,3,&ast; Jia Sun,1,2 Yangzi Zhu,1,2 Long Wang,1,2 Meiyan Zhou,1,2 Liwei Wang1– 3 1The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China; 3College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meiyan Zhou; Liwei Wang, The Xuzhou Clinical College of Xuzhou Medical University, Department of Anesthesiology, Xuzhou Central Hospital, No. 199, Jiefang South Road, Xuzhou, Jiangsu, People’s Republic of China, Email [email protected] ; [email protected]: The quality of postoperative recovery under enhanced recovery after surgery protocols has always been the focus of anesthesiologists. It has been proven that esketamine application during the perioperative period can reduce the use of opioid drugs and improve the quality of postoperative recovery. The present study explored the effect of the esketamine-based opioid-sparing anesthesia protocol on the quality of postoperative recovery in patients undergoing elective urological surgery.Patients and Methods: A randomized, double-blind, controlled clinical trial was adopted. Patients aged 18– 65 years, with American Society of Anesthesiologists physical status grades I–III, scheduled for elective laparoscopic partial nephrectomy or unilateral nephrectomy in urological surgery, were randomly divided into the OSA group and the control group. The OSA group received 0.25 mg/kg of esketamine for anesthesia induction during the operation, and maintenance was carried out at a rate of 0.125 mg·kg⁻¹·h⁻¹. The primary outcome measure was the Quality of Recovery Scale-15 score 24 hours after the operation.Results: The total Quality of Recovery Scale-15 score was significantly higher in the OSA than in control groups 24 hours after the operation (114 [108, 116] vs 106 [102, 109], p < 0.001). The anesthesia recovery level was better in the OSA than in control groups in the post-anesthesia care unit, demonstrated by shorter eye-opening time (19 [17 20] vs 22 [18, 22], p = 0.031) and extubation time (20 [20, 23] vs 25 [20, 25], p = 0.004). Additionally, the incidence of nausea and vomiting within 0– 48 hours after surgery was lower in the OSA than in control groups.Conclusion: The esketamine-based opioid-sparing anesthesia protocol can improve the quality of early postoperative recovery and the level of anesthesia recovery, and accelerate rehabilitation in patients undergoing elective urological surgery.Keywords: esketamine, opioid-sparing anesthesia, quality of recovery, postoperative pain, nephrectomy