Esketamine for Postoperative Anxiety After Major Abdominal Tumor Surgery: A Randomized Clinical Trial
Xiaoying Cui, Wutao Chen, Jinyu Wang, Xiaobing Xiang, Meijuan Zhu, Ze Chai, Siqun Xiao, Shunv Cai, Pingbo Xu, Wen Zhang
Drug Design Development and Therapy September 1, 2026 DOI: 10.2147/dddt.s632479 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 180 |
| Population | Patients with preoperative anxiety scheduled for major abdominal tumor surgery |
| Interventions | Esketamine placebo |
| Duration | Follow-up to postoperative day 30 |
| Measures | Hamilton Anxiety Rating Scale (HAMA) |
| Topics | Anxiety Esketamine |
| Key findings | Esketamine did not reduce postoperative anxiety in patients with preoperative anxiety undergoing major abdominal tumor surgery: response rates on postoperative day 3 were 39.5% with esketamine versus 42.5% with placebo, and anxiety scores were similar at days 3 and 30. Esketamine was associated with lower depressive symptom scores at day 30. |
Abstract
Purpose: Postoperative anxiety is common in surgical patients and may impair recovery, especially in the patients with preoperative anxiety. However, effective strategies for treating postoperative anxiety remain limited. We hypothesized that esketamine could reduce postoperative anxiety in patients with preoperative anxiety undergoing major abdominal tumor surgery. Patients and
Methods: 180 patients with preoperative anxiety scheduled for major abdominal surgery were randomly assigned to either esketamine or placebo. The primary outcome was the response rate on postoperative day 3 (POD3), defined as a ≥ 50% reduction from baseline Hamilton Anxiety Rating Scale (HAMA) score. Secondary outcomes included HAMA score on POD3 and POD30, depression and quality of recovery on POD3 and POD30, sleep quality on POD1-3 and POD30.
Results: 86 patients in the esketamine group and 87 patients in the placebo group were analyzed. On POD3, the positive response rate was 39.5% in the esketamine group and 42.5% in the placebo group (risk ratio, 0.93; 95% CI, 0.65 to 1.33; P = 0.81). The secondary outcomes showed that HAMA scores were similar between groups at POD3 (median [IQR], 6 [3– 10] vs 7 [4– 11]; adjusted mean difference, 0; 95% CI, − 2 to 1; P = 0.59) and at POD30 (5 [3– 8] vs 7 [4– 11]; adjusted mean difference, − 1; 95% CI, − 3 to 1; P = 0.28). Patients in the esketamine group also demonstrated lower scores for depressive symptoms on POD30 (median [IQR], 5 [2– 8] vs 6 [3– 10]; adjusted mean difference, − 2; 95% CI, − 3 to − 1; P = 0.001).
Conclusion: Esketamine did not reduce anxiety in patients with preoperative anxiety undergoing major abdominal tumor surgery on POD3 and POD30. Keywords: abdominal tumor surgery, anxiety, depression, esketamine, sleep quality