Effects of Intravenous Esketamine or Magnesium Sulfate on Early Postoperative Negative Emotions and Pain in Patients Undergoing Endoscopic Sinus Surgery: A Randomized Controlled Trial

Background: N-methyl-D-aspartate (NMDA) receptor antagonists are crucial for managing perioperative pain and psychological distress. Both esketamine and magnesium sulfate are NMDA receptor antagonists. This study compared their effects on early postoperative negative emotions and pain in patients undergoing endoscopic sinus surgery (ESS). Methods: This study involved 137 patients scheduled for ESS were randomly assigned to three groups: Group E (esketamine), Group M (magnesium sulfate), and Group C (saline control). Before induction, Group E received esketamine 0.25 mg/kg loading over 10 min then 0.25 mg/(kg·h) infusion until surgery end; Group M received magnesium sulfate 30 mg/kg loading over 10 min then 10 mg/(kg·h) infusion until surgery end; Group C received equal volume of normal saline. Hospital Anxiety and Depression Scale (HADS) and Self-rating Anxiety/Depression Scale (SAS/SDS) scores were assessed on postoperative days 1 and 2 (POD1, POD2). VAS scores, hemodynamics, intraoperative drug use, and adverse events were also evaluated. Results: On POD1, HADS, SAS, and SDS scores were significantly lower in Groups E and M than in Group C ( P < 0.05). On POD2, these scores were lower in Group E than in Groups C and M( P < 0.05). VAS pain scores were significantly lower in Groups E and M at 2, 4, and 8 hours postoperatively ( P < 0.001). Remifentanil consumption was lower in Groups E and M than in Group C ( P < 0.05), nitroglycerin consumption was lower in Group M than in Group E ( P < 0.05). Incidences of sore throat, rescue analgesia, postoperative respiratory depression, and PONV in Groups E and M were significantly lower than those in Group C ( P < 0.05). Conclusion: Intravenous esketamine or magnesium sulfate effectively alleviated negative emotions and pain on POD1 in patients undergoing ESS.Esketamine demonstrated superior efficacy over magnesium sulfate on POD2. Keywords: esketamine, magnesium sulfate, anxiety, depression, postoperative pain, endoscopic sinus surgery