Effect Of Esketamine On Postoperative Depression In Patients Undergoing Thoracoscopic Lung Cancer Surgery: A Randomized Controlled Trial

Background:Depressive symptoms are very common in patients with lung cancer,and studies have shown that ketamine has certain therapeutic effect on depression.Esketamine has similar pharmacological characteristics to ketamine and has been widely used in clinical practice.Therefore,this study intends to observe the effect of esketamine on postoperative depression in patients with thoracoscopic lung cancer.Methods:In this randomized,double-blind,placebo-controlled trial,156 patients undergoing thoracoscopic lung cancer surgery were randomly allocated in a 1:1 ratio to receive intravenous esketamine(intraoperatively and in patient-controlled analgesia until 48 h postoperatively)or normal saline placebo.The primary outcome was the incidence of depression at 1 month postoperatively,assessed using the Beck Depression Inventory-Ⅱ(BDI-Ⅱ).Secondary outcomes included depression incidence(at 48 h postoperatively.hospital discharge and 3 months postoperatively),BDI-Ⅱ scores,anxiety incidence,Beck Anxiety Inventory scores,Quality of Recovery-15(QoR-15)scores,and 1-and 3-month mortality.Results:A total of 151 patients(75 in the esketamine group and 76 in the normal saline group)completed the 1-month follow-up.The esketamine group had a significantly lower incidence of depression at 1 month than the normal saline group(1.3%[1 of 75]vs.11.8%[9 of 76];relative risk.0.10;95%CI,0.01 to 0.82;P=0.023).After excluding patients with non-cancerous lesions,the depression incidence was also lower in the esketamine group(1.4%vs 12.2%;relative risk,0.10,95%CI,0.01 to 0.83).The secondary outcomes were similar between groups,except that the esketamine group had higher QoR-15 scores at 1 month postoperatively(median difference =2;95%CI,0 to 5:P=0.048).There were no significant differences in other secondary outcomes.The independent risk factors for depression were hypertension(odds ratio=6.75.95%CI,1.13 to 40.31:P=0.036)and preoperative anxiety(odds ratio=23.83,95%CI,3.41 to 166.33:P=0.001).Conclusions:Perioperative administration of esketamine reduced the incidence of depression 1 month after thoracoscopic lung cancer surgery.History of hypertension and preoperative anxiety were independent risk factors for depression.