Intraoperative Low-Dose S-Ketamine Reduces Depressive Symptoms in Patients with Crohn’s Disease Undergoing Bowel Resection: A Randomized Controlled Trial
Zhen Zhang, Wen-Hao Zhang, Yin Lu, Bo-Xuan Lu, Yi-Bo Wang, L. Cui, Hao Cheng, Zhenyu Yuan, Jie Zhang, Da-peng Gao, J. Gong, Qing Ji
Journal of Clinical Medicine February 1, 2023 DOI: 10.3390/jcm12031152 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 124 |
| Population | Adult patients with Crohn's disease undergoing bowel resection with mild to moderate depression |
| Interventions | S-ketamine 0.9% saline |
| Dose | 0.25 mg/kg intravenous drip followed by continuous infusion of 0.12 mg/kg/h for more than 30 min |
| Duration | Follow-up through postoperative day 7 |
| Measures | 17-item Hamilton depression Scale (HAMD-17), nine-item patient health questionnaire (PHQ-9), quality of recovery (QoR-15) form, numeric rating scale (NRS), C-reactive protein (CRP), interleukin 6 (IL-6) |
| Topics | Esketamine Ketamine |
| Key findings | Intraoperative low-dose S-ketamine reduced depression scores (HAMD-17, PHQ-9) and postoperative pain scores and improved quality of recovery compared with placebo, without worsening safety. CRP, IL-6, postoperative complications, and hospital stay did not differ between groups. |
Abstract
Background: Patients with Crohn’s disease (CD) undergoing bowel resection often suffer from depression and acute pain, which severely impairs their recovery. We aimed to investigate the effects of S-ketamine preconditioning on postoperative depression in patients with CD undergoing a bowel resection with mild to moderate depression and to observe whether it can relieve postoperative pain and anti-inflammation.
Methods: A total of 124 adult patients were randomized into one of the two groups. Patients in the S-ketamine group received a 0.25 mg/kg S-ketamine intravenous drip under general anesthesia induction, followed by a continuous infusion of S-ketamine with 0.12 mg/kg/h for more than 30 min through target-controlled infusion. Patients in the placebo group received 0.9% saline at an identical volume and rate. The primary outcome measure was the 17-item Hamilton depression Scale (HAMD-17). The secondary outcomes were scores on the following questionnaires: a nine-item patient health questionnaire (PHQ-9); a quality of recovery (QoR-15) form; and a numeric rating scale (NRS). Additional secondary outcomes included the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) on postoperative days (PODs) 1, 3, and 5, the length of hospital stay, and opioid use throughout the hospital stay.
Results: The scores of PHQ-9 and HAMD-17 in the S-ketamine group were lower than those in the placebo group on postoperative days (PODs) 1, 2, and 7 (p < 0.05). The scores of QoR-15 in the S-ketamine group were higher than those in the placebo group on postoperative days (PODs) 3 and 5 (p < 0.05). The NRS scores of PACU, postoperative days 1 and 2 in the S-ketamine group were lower than those in the placebo group (p < 0.05). There was no significant difference in the CRP and IL-6 levels on postoperative days (PODs) 1, 3, and 5, postoperative complications, and hospital stay between the two groups (p > 0.05).
Conclusions: The trial indicated that the intraoperative administration of low-dose S-ketamine could alleviate mild-to-moderate depressive symptoms and postoperative pain in patients with Crohn’s disease undergoing bowel resection without worsening their safety.
Comparable studies
Other randomized controlled trials on esketamine, most cited first.