Effect of esketamine on opioid consumption and postoperative pain in
thyroidectomy: a randomized controlled trial
Abstract
Aim: Thyroidectomy is frequently associated with substantial
postoperative pain. Esketamine, an N-methyl-D-aspartate receptor
antagonist, has been demonstrated to be effective in multiple analgesia.
We hypothesized that intraoperative administration of esketamine may
reduce perioperative opioid consumption and postoperative pain in
patients undergoing thyroidectomy. Methods: Sixty patients undergoing
thyroidectomy were randomly assigned to two groups. Patients in the
saline group received a pre-incisional intravenous bolus of 0.9% NaCl
followed by an intraoperative infusion of 0.9% NaCl; patients in the
esketamine group received a pre-incisional intravenous bolus of
esketamine (0.5 mg kg-1) followed by an intraoperative infusion of
esketamine (0.24 mg kg-1 h-1). The primary outcome was perioperative
sufentanil consumption. The postoperative pain, sleep quality, and
adverse events during the first postoperative 24 h were also evaluated.
Results: Patients in the esketamine group consumed significantly less
sufentanil than those in the saline group (24.6 ± 3.1 μg vs. 33.7 ± 5.1
μg, mean difference, 9.1; 95% confidence interval, 6.9–11.3, P
<0.001). Postoperative pain scores were significantly lower in
the esketamine group than those in the saline group during the first 24
h postoperatively (P <0.05). Patients receiving esketamine
experienced higher sleep quality than those in the saline group during
surgical night (P = 0.043). There were no significant differences in
adverse events between the two groups. Conclusion: Intraoperative
administration of esketamine reduces perioperative sufentanil
consumption and postoperative pain without increasing adverse events in
patients undergoing thyroidectomy. The development of combined
anesthesia regimens, including esketamine, may foster strategies for
pain management during thyroidectomy.