Effectiveness of adding esketamine to dexmedetomidine for sedation and analgesia during radiofrequency ablation and saphenous vein stripping: a randomized controlled trial

BACKGROUND: To evaluate the efficacy and safety of low-dose esketamine combined with dexmedetomidine for sedation and analgesia during surgery under local anesthesia. METHODS: This randomized controlled trial was conducted at Beijing LuHe Hospital from March 2023 to August 2024. The study included patients undergoing radiofrequency ablation (RA) and saphenous vein stripping (SVS). Participants were randomly allocated into three groups: the control group (Group D) received dexmedetomidine alone, the experimental group (Group DE) received dexmedetomidine and esketamine (0.125 mg/kg), and the experimental group (Group DF) received dexmedetomidine and fentanyl (1 μg/kg). The primary outcome measure was the visual analog scale (VAS) score for the highest level of intraoperative pain. RESULTS: Overall, 183 patients were included in the full analysis set (61 per group). After completing the per-protocol analysis, 60 patients in Group D, 59 in Group DE, and 59 in Group DF were analyzed. The VAS pain scores were significantly lower in both the DE and DF groups compared to Group D (2.95±1.53 vs. 4.53±1.73; 3.31±1.78 vs. 4.53±1.73; both P<0.001). Regarding collateral effects, group DF had increased incidence of bradycardia, decreased HR, and significantly increased respiratory depression compared to group DE. CONCLUSIONS: Both experimental groups (DF and DE) provide effective analgesia and sedation during RA of the great saphenous vein under local anesthesia. However, in our study, low-dose esketamine combined with dexmedetomidine (group DE) is superior due to better cardiovascular stability that is achieved compared to dexmedetomidine and fentanyl (group DF). This combination may serve as a promising adjuvant analgesic and sedative regimen for surgeries conducted under local anesthesia.