Abstract
Aim:
Thyroidectomy is frequently associated with substantial postoperative
pain.
Esketamine,
an N-methyl-D-aspartate receptor antagonist, has been demonstrated to be
effective in multiple analgesia. We hypothesized that intraoperative
administration of esketamine may reduce perioperative opioid consumption
and postoperative pain in patients undergoing thyroidectomy.
Methods: Sixty patients undergoing thyroidectomy were randomly assigned
to two groups. Patients in the saline group received a pre-incisional
intravenous bolus of 0.9% NaCl followed by an intraoperative infusion
of 0.9% NaCl; patients in the esketamine group received a
pre-incisional intravenous bolus of esketamine (0.5 mg
kg-1) followed by an intraoperative infusion of
esketamine (0.24 mg kg-1 h-1). The
primary outcome was perioperative sufentanil consumption. The
postoperative pain, sleep quality, and adverse events during the first
postoperative 24 h were also evaluated.
Results: Patients in the esketamine group consumed significantly less
sufentanil than those in the saline group (24.6 ± 3.1 μg vs. 33.7 ± 5.1
μg, mean difference, 9.1; 95% confidence interval, 6.9–11.3, P<0.001). Postoperative pain scores were significantly lower in
the esketamine group than those in the saline group during the first 24
h postoperatively (P <0.05). Patients receiving
esketamine experienced higher sleep quality than those in the saline
group during surgical night (P = 0.043). There were no
significant differences in adverse events between the two groups.
Conclusion: Intraoperative administration of esketamine reduces
perioperative sufentanil consumption and postoperative pain without
increasing adverse events in patients undergoing thyroidectomy. The
development of combined anesthesia regimens, including esketamine, may
foster strategies for pain management during thyroidectomy.