Introduction
Thyroid surgeries have evolved into safe procedures with low morbidity
and mortality.1 Concerns with surgery are most
commonly associated with postoperative pain, which results from
extensive tissue dissection and tension. Opioids are the most potent
analgesics in clinical anesthesia; however, prescription opioids are a
substantial contributor to drug-related adverse effects and the risk of
dependence and abuse.2 Thus, reducing postsurgical
pain using opioid-sparing techniques can have long-term
benefits.3 Multimodal analgesia is useful in reducing
opioid consumption following myriad surgeries, including orthopedic,
gynecologic, colorectal, and bariatric surgery. Nonetheless, the
adoption of multimodal analgesia in head and neck surgeries has lagged.
Ketamine inhibits N-methyl-d-aspartate (NMDA) receptor activation and
attenuates the wind-up and central sensitization associated with
hyperalgesia, opioid tolerance, and chronic pain.4Numerous publications have stated that adjuvant ketamine reduces
postoperative pain and opioid consumption
postoperatively.5-8 However, the psychotomimetic
effects of ketamine, such as visual disturbances and dizziness, can
compromise patient satisfaction. Esketamine, the left-handed optical
isomer of racemic ketamine, is purported to have higher potency and a
lower incidence of adverse events than racemic
ketamine.9 In this randomized controlled trial, we
evaluated the opioid-sparing effect of esketamine during thyroid
surgery. The primary outcome was perioperative sufentanil consumption.
Pain and sleep quality during the first 24 h postoperatively were
recorded as secondary outcomes. We hypothesized that the administration
of esketamine would reduce perioperative sufentanil consumption, along
with better pain control and sleep quality 24 h after surgery.