Effects Of Low-dose Esketamine On Quality Of Recovery In Patients After Lumbar Surgery

BackgroundPosterior lumbar fusion(PLF)is associated with severe acute postoperative pain,which may induce or worsen the occurrence of negative mood,reduce the patient compliance,affect postoperative rehabilitation training and quality of life.Esketamine,has powerful analgesic and mood-improving effects.Several studies suggest that perioperative application of low-dose eskatmine can reduce postsurgical pain,reduce opioid related adverse via decrease opioid consumption,improve emotion and recovery quality of patients.However,no studies have been conducted to investigate the effect of low-dose esketamine on the quality of recovery in patients undergoing PLF.ObjectiveThe study aims to investigate the effect of low-dose esketemine on postoperative quality of recovery in patients undergoing PLF.MethodsThis study was a prospective,randomized,double-blind,placebo-controlled trail.Fifty-six patients undergoing elective PLF were randomly into two groups(28 cases in each group):experimental group(group EK)or control group(group C).Group EK received esketamine(inject 0.2mg/kg at induction,followed by an infusion of 0.125 mg/kg/h until the wound closure,postoperative patient-controlled analgesia with 0.9mg/kg esketamine plus 1.8ug/kg sufentanil plus 10mg tropisetron=120ml).Group C received equally volumes of saline during induction and operation,postoperative PCIA with 1.8ug/kg sufentanil plus 10mg tropisetron=120ml.The primary outcome was quality of recovery for patients using the Quality of Recovery-15(QoR-15),which measured at 24 and 48h after surgery.8-point change on QoR-15 scores is the minimum clinically important difference(MCID).Difference smaller than this were considered unlikely to be important clinically.The secondary outcomes included hemodynamics,intraoperative medication,NRS score at rest and movement,quality of awakening,sufentanil consumption after surgery,number cases of rescue analgesia,the time to flatus and get out of bed,length of hospital day,and adverse events.ResultsThe final analysis included 53 patients,27 in the Group EK and 26 in the Group C.The general clinical information was similar between the two group(P>0.05).The QoR-15 scores at 24h postoperatively was higher in the Group EK compared with the Group C[mean(SD),111.04±6.89 vs 106.38±7.85,P=0.026],but the between-group difference in the QoR-15 scores was not exceeded the MCID,indicating no clinically important significance.There was no statistically significant difference between the two groups in QoR-15 scores at 48 h postoperatively(P>0.05).The NRS pain scores in the resting state at 1h and 4h after in group EK were lower than in the Group C(P<0.05);The two groups showed similar pain scores at rest at 8h,12h,24h,48h after surgery and at movement at 4h,8h,12h,24h,48h(P>0.05).Compared with Group C,the lowest blood pressure in the period of induction-preintubation was higher in patients assigned to Group EK(P<0.05).There was no statistically significant difference between the two groups for intraoperative medication(P>0.05).Sedation score was lower in Group EK than in the Group C 10min after extubation(P<0.05).Both of the number of cases rescue analgesia and sufentanil consumption during the PACU were less in Group EK versus in Group C(P<0.05);total dose of sufentanil used during the 48h after operation and the number of cases rescue analgesia in the ward between the two groups were not significant difference(P>0.05).There were no statistically significant difference between two groups in the time to flatus and get out of bed,length of hospital day,and adverse events(P>0.05).ConclusionLow-dose esketamine does not significantly improve the quality of recovery in patients undergoing posterior lumbar fusion.