Preoperative Anxiety's Impact on the Median Effective Dose of Esketamine for Alleviating Propofol Injection Pain in Patients Undergoing Painless abortion: A Randomized, Double-Blind, Controlled Trial.
Yanping Shen, Lijun Yin, Binnan Hu, Yilun Xia, Liangguang Zhang
Drug Design, Development and Therapy 2024 DOI: 10.2147/DDDT.S482019 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 150 |
| Population | Patients scheduled for painless abortion |
| Intervention | Esketamine |
| Dose | 0.10, 0.12, 0.14, 0.17, or 0.20 mg/kg |
| Topics | Esketamine Anxiety |
| Keywords | Dose-response Painless abortion Preoperative anxiety Propofol injection pain Anxiety-and-pain-management Anesthesia-dosing Medical-procedures Reproductive-healthcare Drug-interactions |
| Citations | 7 |
| Key findings | Preoperative anxiety significantly increases the ED50 of esketamine required to alleviate propofol injection pain, with anxious patients needing 0.133 mg/kg versus 0.114 mg/kg for non-anxious patients. |
Abstract
Propofol injection pain (PIP) is a frequent adverse effect during anesthesia induction, impacting patient comfort and satisfaction. Esketamine has been shown to alleviate PIP, but the optimal dose, especially in relation to preoperative anxiety levels, remains unclear. Preoperative anxiety may heighten pain perception and influence analgesic requirements. A randomized, double-blind, controlled trial was conducted at The Affiliated Women and Children's Hospital of Ningbo University. A total of 150 eligible patients scheduled for painless abortion were assessed using the Spielberger State Anxiety Inventory - State form (STAI-S) and categorized into non-anxious (STAI-S score <40) and anxious (STAI-S score ≥40) groups. Patients were randomized using a computer-generated random number table to receive one of five escalating doses of esketamine (0.10, 0.12, 0.14, 0.17, or 0.20 mg/kg) prior to propofol administration. The primary outcome was the occurrence of PIP, assessed using Ambesh's four-point pain scale. Secondary outcomes included hemodynamic parameters and adverse events such as hypotension, bradycardia, and hypoxemia. A clear dose-response relationship was observed, with higher doses of esketamine significantly reducing the incidence of PIP in both groups. Anxious patients required higher doses of esketamine to achieve comparable pain relief to non-anxious patients. The effective dose for 50% of patients (ED50) in the non-anxious group was 0.114 mg/kg (95% CI: 0.096-0.129 mg/kg), whereas it was 0.133 mg/kg (95% CI: 0.117-0.146 mg/kg) in the anxious group, with the difference being statistically significant (P < 0.05). No significant differences were observed between groups in terms of adverse events or hemodynamic stability. Preoperative anxiety significantly increases the ED50 of esketamine required to alleviate propofol injection pain in patients undergoing painless abortion. Anxious patients require higher doses of esketamine to achieve effective analgesia. Individualizing esketamine dosing based on preoperative anxiety levels may enhance patient comfort and optimize pain management during anesthesia.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Preoperative anxiety increased the esketamine dose needed to alleviate propofol injection pain, with anxious patients requiring 0.133 mg/kg versus 0.114 mg/kg for non-anxious patients.
Synthesized
Comparable studies
Other randomized controlled trials on esketamine for anxiety, most cited first.