Effect Of Esketamine-based Opioid-sparing Anesthesia Strategy On Postoperative Recovery Quality In Patients Undergoing Total Laparoscopic Hysterectomy

Object: Esketamine-based opioid-sparing anesthesia is an emerging technique that reduces intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events.The present study investigated the effect of esketamine-based opioid-sparing anesthesia strategy on the quality of recovery in patients undergoing total laparoscopic hysterectomy.Methods: Ninety patients who underwent elective laparoscopic total hysterectomy and met the inclusion and exclusion criteria at the First Affiliated Hospital of Shihezi University were selected and divided into two groups using a random number method.Patients were randomly assigned to opioid-sparing anesthesia based on esketamine(group K)or traditional opioid-based anesthesia(group C).Patients,surgeons,and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation.For group C,intravenous injections of 0.05 mg/kg midazolam,1.5-2 mg/kg propofol,and 0.5ug/kg sufentanil were used to produce anesthesia.Rocuronium 0.6 mg/kg was injected following confirmation of loss of consciousness(LOC),which is defined as loss of verbal responsiveness and eyelash reaction.And maintained with 4–6 mg/kg/h propofol and 0.15–0.30 ug/kg/min remifentanil after intubation.Anesthesia in group K was induced by iv.injection of 8mg dexamethasone,0.05 mg/kg midazolam,1.5-2mg/kg propofol,0.3 ug/kg sufentanil,0.3 mg/kg esketamine,0.6 mg/kg rocuronium,and maintained with4–6 mg/kg/h propofol,0.06–0.1 ug/kg/min remifentanil and 0.125 mg/kg/h esketamine after intubation.Esketamine and propofol infusions were stopped at the beginning of skin suturing and remifentanil infusion was stopped at the end of the skin suturing.The primary outcomes were the quality of recovery measured using the Quality of Recovery-40(Qo R-40)questionnaire and Visual Analogue Scale(VAS).Secondary outcomes were postoperative opioid-related adverse events,perioperative opioid consumption and intraoperative hemodynamics parameters after surgery.The primary outcomes of this study were Qo R-40 on postoperative day 1 and pain in the PACU and ward including maximal VAS pain scores within the 6th,24 th and 48 th postoperative hours.Additional assessments included the following: total amount of propofol,remifentanil,and sufentanil administered during surgery,hemodynamic data including MAP,HR,and Sp O2 before and after induction,immediately after tracheal intubation,after artificial pneumoperitoneum,at cessation of anesthetics,immediately after extubation,and profiles of postoperative opioid-related adverse events.Results: The patients in both groups had comparable baseline characteristics.Qo R-40 scores were higher in group K than in group C on postoperative day 1(P<0.01);scores of physical comfort,emotional state and pain were higher than those of group C,with statistical significance.VAS scores in the PACU and ward were lower in group K when compared with group C(P<0.05 for each).The incidences of nausea and vomiting within 24 h after surgery were also significantly lower in group K(P<0.05 for each).The total dose of sufentanil,remifentanil and propofol were all significantly lower in the group K than in the group C(P<0.05),HR and MAP in group K at time T1 and T2 were higher than those in group C(P<0.05).The proportion of patients who used ephedrine in surgery was higher in group C than in the group K(P<0.05).Conclusion: Esketamine-based opioid-sparing anesthesia strategy is feasible and enhance postoperative recovery by reducing opioid-related side effects and pain scores compared to an opioid-based anesthetic regimen.