Effect of intraoperative low-dose esketamine infusion on postoperative sleep disturbance after laparoscopic cholecystectomy: a randomized clinical trial.
Yanan Wu, Yaning Yang, Xiaomei Wang, Li Sun, Yunpeng Hei, Yuhua Zou, Zhenhai Ye, Zhi Yu
BMC Anesthesiology July 1, 2025 DOI: 10.1186/s12871-025-03180-1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Placebo-controlled Double-blind Peer reviewed |
|---|---|
| Sample size | 86 |
| Population | Patients aged ≥ 18 years, ASA I to III, BMI 18 to 30 kg/m², undergoing laparoscopic cholecystectomy |
| Intervention | Esketamine |
| Dose | 0.5 mg/kg/h |
| Duration | Intraoperative infusion, follow-up through postoperative day 3 |
| Topics | Esketamine |
| Keywords | Laparoscopic cholecystectomy Postoperative sleep disturbance Ketamine derivative Anesthetic agent Sleep disruption Post-surgical sleep issues Insomnia Sleep quality Pain management Analgesia Opioid reduction Postoperative pain Postoperative care Post-surgical recovery Patient outcomes Minimally invasive surgery |
| Citations | 9 |
| Key findings | Intraoperative esketamine infusion significantly lowered the incidence of postoperative sleep disturbance on each of the first three postoperative days compared with placebo. |
Abstract
Postoperative sleep disturbance (PSD) is a common surgical complication. In this study, we investigated the effect of intraoperative esketamine infusion on the incidence of PSD in patients who underwent laparoscopic cholecystectomy. A single-center, double-blinded, placebo-controlled randomized clinical trial was perfomed from May to August 2024 at the People's Hospital of Ningxia Hui Autonomous Region. Study participants included patients aged ≥ 18 years, ASA classification of I to III, BMI of 18 to 30 kg/m2 and underwent laparoscopic cholecystectomy. Patients were randomly assigned to esketamine group or placebo group using a random number table method. Patients in the esketamine group received continuous intraoperative infusion of esketamine, 0.5 mg/kg/h while those in the placebo group were given an equal volume of normal saline. The primary outcome was PSD incidence within 1-3 postoperative days (PODs). PSD was defined as numerical rating scale score of 6 or higher or Athens Insomnia Scale score of 6 or higher. Secondary outcomes were postoperative pain (using visual analog scale), intraoperative remifentanil consumption, postoperative adverse reactions, and PSD-related risk factors. Eighty-six patients were randomly assigned to esketamine group (n = 43; mean [SD] age, 47.9 [9.4] years) and placebo groups (n = 43; mean [SD] age, 49.7 [15.1] years). The incidence of PSD in the esketamine group was significantly lower than in the control group on POD 1 (58.1% vs. 81.4%; odds ratio [OR], 0.32 [95%Cl, 0.12-0.84]; P = 0.019) and POD 2 (11.6% vs. 44.2%; OR, 0.17 [95%Cl, 0.06-0.50]; P = 0.001) and POD3 (2.3% vs. 18.6%; OR, 0.10 [95%Cl, 0.01-0.87]; P = 0.035). Postoperative pain score and intraoperative remifentanil consumption in the esketamine group were lower than those in the placebo group (all P < 0.05). There was no difference in postoperative adverse reactions between the two groups. Multivariate logistic regression analysis showed that operation duration (P = 0.049), ASA grade (P = 0.044), and drain insertion (P = 0.021) were independent risk factors for PSD. Intraoperative infusion of low-dose esketamine can prevent the incidence of PSD in patients undergoing laparoscopic cholecystectomy. Further studies are required to confirm these results. Chinese Clinical Trial Registry (ChiCTR2400083826).