The Comparison of the Efficacy of Esketamine Over Sufentanil to Reduce Postoperative Nausea and Vomiting in Gynecological Laparoscopic Surgery: A Prospective, Double-Blind, Randomized Controlled Trial

Zhuolin Qiu,1,* Yue Guo,1,* Weilong Zhong,1,* Weiqiang Chen,2 Ping Xiang,3 Jianfen Liang,1 Jingyi Du,1 Xiang Li1,2 1Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Anesthesiology, Zhaoqing Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Zhaoqing, Guangdong, People’s Republic of China; 3Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Li, Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, People’s Republic of China, Email [email protected]: Postoperative nausea and vomiting (PONV) affect 40– 80% of patients undergoing gynecological laparoscopy (GLS). Opioids, though effective for analgesia, may exacerbate PONV. Esketamine, the dextrorotatory form of ketamine with analgesic, sedation and anti-inflammatory properties, was evaluated for PONV prophylaxis compared to sufentanil.Methods: In this single-center, double-blind trial, 150 patients undergoing elective GLS were randomized to receive esketamine (0.25mg/kg, n=75) or sufentanil (0.1μg/kg, n=75) at the incision closing. Primary outcomes were PONV incidence and severity in Postanesthesia care unit (PACU) and during 48 hours postoperation. Secondary outcomes included pain scores, supplemental analgesia use, sore throat and bucking at excubation. Statistical analyses utilized t-tests, Mann–Whitney U, and χ²-tests (significance: p < 0.05) with Friedman test for within-group comparisons and generalized estimating equations (GEE) for group-time interaction evaluation.Results: The esketamine group demonstrated significantly lower PONV incidence (in PACU: 57.3% vs 36%, p=0.014; 24h: 53.3% vs 36%, p=0.048) and reduced severity within 24 hours (in PACU, p< 0.001; 6h, P=0.042; 24h, p=0.029). Secondary outcomes favored esketamine: lower dynamic pain scores during coughing (in PACU, p=0.017; 6h, P=0.021; 24h, p=0.012), lower severity of sore throat (6h, P=0.019; 24h, p=0.028), reduced rescue analgesia needs (6h: RD=0.12, p=0.037), and decreased incidence of bucking reflex (RD=0.21, p=0.014).Conclusion: Single-dose esketamine significantly reduces PONV incidence and severity in GLS, improves dynamic analgesia, and mitigates extubation complications. These results support the single dose use of esketamine as an opioid-sparing adjunct to prevent PONV in gynecological laparoscopy.Keywords: postoperative nausea and vomiting, esketamine, gynecological laparoscopy, general anesthesia, opioids