Esketamine-based PCIA combined with intercostal nerve block for acute pain after lobectomy: a randomized controlled trial
Mi Zhou, Y M Qi, Fan Zhou, Hui Wu, Jiao Chen, Long Wang, Liwei Wang
Frontiers in Pharmacology March 4, 2026 DOI: 10.3389/fphar.2026.1746121 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 360 |
| Population | Patients undergoing thoracoscopic lobectomy at Xuzhou Central Hospital |
| Interventions | Esketamine Sufentanil Intercostal nerve block |
| Dose | 0.03 mg/kg/h esketamine; 0.015 mg/kg/h esketamine; 0.03 μg/kg/h sufentanil |
| Duration | 72 hours postoperative |
| Topics | Ketamine Esketamine |
| Keywords | Randomized controlled trial Sufentanil Incidence geometry Adverse effect Nausea Vomiting Intercostal nerves Anesthesia Surgery Acute pain Patient-controlled analgesia Pain scale Nerve block Ropivacaine |
| Key findings | A moderate dose of esketamine (0.03 mg/kg/h) in patient-controlled intravenous analgesia combined with preoperative intercostal nerve block significantly reduced acute postoperative pain and lowered the incidence of postoperative nausea and vomiting compared to sufentanil alone. |
Abstract
Objective: To evaluate outcomes of different doses of esketamine in postoperative patient-controlled intravenous analgesia (PCIA) combined with preoperative intercostal nerve block (ICNB) analgesia protocol for acute postoperative pain (APP) relief in patients undergoing thoracoscopic lobectomy. Materials and methods A total of 360 patients scheduled for thoracoscopic lobectomy at Xuzhou Central Hospital between October 2021 and July 2023 were enrolled and randomly assigned into three groups using the random envelope method. Before anesthesia induction, all patients received ICNB, followed by general anesthesia. Group C received PCIA using sufentanil at 0.03 μg/kg/h, Group K1 received a low dose of esketamine at 0.015 mg/kg/h in PCIA, and Group K2 received a moderate dose of esketamine at 0.03 mg/kg/h in PCIA. Numerical Rating Scale (NRS) pain scores were recorded at 2, 4, 24, 48, and 72 h postoperatively. The incidence of APP within 72 h post-surgery, the requirement for rescue analgesia and the occurrence of adverse reactions, were assessed and recorded for the three groups.
Results: There were significantly lower NRS scores in Group K2 at 2, 4, 24, 48, and 72 h postoperatively, compared to Groups C and K1 (P < 0.01). However, there were no statistically significant differences in NRS scores between Group C and Group K1 (P > 0.05). The incidence of APP within 72 h postoperatively was significantly lower in Group K2, compared to Group C and Group K1 (P < 0.05). Additionally, Group C exhibited a significantly higher the incidence of postoperative nausea and vomiting (PONV) than the other two groups (P < 0.05). Group K2 demonstrated superior postoperative analgesic efficacy, including reduced rescue analgesia needs and lower opioid consumption, without affecting hospital stay length compared to Groups C and K1.
Conclusion: A dose of 0.03 mg/kg/h esketamine in PCIA combined with preoperative ICNB significantly alleviates APP in patients undergoing thoracoscopic lobectomy, reducing resting pain scores by approximately 30% at 24 h compared to sufentanil-based analgesia. Clinical Trial Registration https://www.chictr.org.cn/ , Identifier ChiCTR2100051000.