Xie Jue, Shen Fangming, Wang Xingming, Yao Juan, Zhou Lingzhen, Huang Luxin, Sun Jie
Department of Anesthesiology, Surgery and Pain Management & Key Laboratory of Clinical Science and Research, Zhongda Hospital Southeast University, Southeast University School of Medicine, Nanjing, Jiangsu, People's Republic of China.
Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
Ther Clin Risk Manag. 2025 Jul 5;21:1033-1044. doi: 10.2147/TCRM.S527262. eCollection 2025.
To examine the impact of minimal-dose S-ketamine on postoperative analgesia in patients undergoing minimally invasive radical resection for esophageal cancer, with a focus on reducing opioid consumption, enhancing analgesic quality, and facilitating postoperative recovery.
A total of 216 patients undergoing minimally invasive radical resection of esophageal cancer under general anesthesia were randomly assigned into two groups (S-ketamine and control group), receiving intravenous S-ketamine (0.015 mg/kg/h) or an equal volume of saline for 48 h postoperatively. The primary outcome was cumulative oxycodone consumption in the first 48 h postoperatively. Secondary outcomes included functional activity score (FAS) after one bolus administration, numerical rating scale (NRS) pain scores at rest and when coughing, cumulative oxycodone consumption in different time periods, incidence of postoperative nausea and vomiting (PONV), level of sedation (LOS) score, time to first postoperative flatulence, postoperative delirium, activities of daily living assessed by BI (Barthel Index) and so on.
The postoperative opioid consumption within 48 hours in S-ketamine group was significantly lower than those in placebo group ( < 0.001), and the difference between the two groups was 40% (mean: 44.5 mg vs 74.8 mg). FAS after one bolus administration and BI in the S-ketamine group were notably superior to those in the control group ( < 0.001). There were Statistical differences between the two groups in the NRS scores at rest at postoperative hour 48 ( = 0.001) and the NRS scores when coughing at postoperative hour 12 ( = 0.011) with mean differences of -0.3 and 0.4, respectively.
Minimal-dose S-ketamine for managing acute postoperative pain in patients undergoing radical resection for esophageal cancer led to a 40% reduction in opioid consumption and promoted rehabilitation.
探讨小剂量S-氯胺酮对接受食管癌微创根治性切除术患者术后镇痛的影响，重点关注减少阿片类药物用量、提高镇痛质量及促进术后恢复。
总共216例在全身麻醉下接受食管癌微创根治性切除术的患者被随机分为两组（S-氯胺酮组和对照组），术后48小时内分别接受静脉输注S-氯胺酮（0.015毫克/千克/小时）或等体积生理盐水。主要结局指标为术后48小时内的羟考酮累计用量。次要结局指标包括单次给药后的功能活动评分（FAS）、静息和咳嗽时的数字评分量表（NRS）疼痛评分、不同时间段的羟考酮累计用量、术后恶心呕吐（PONV）发生率、镇静水平（LOS）评分、首次术后排气时间、术后谵妄、通过BI（Barthel指数）评估的日常生活活动能力等。
S-氯胺酮组术后48小时内的阿片类药物用量显著低于安慰剂组（<0.001），两组之间的差异为40%（平均值：44.5毫克对74.8毫克）。S-氯胺酮组单次给药后的FAS和BI明显优于对照组（<0.001）。两组在术后48小时静息时的NRS评分（=0.001）和术后12小时咳嗽时的NRS评分（=0.011）存在统计学差异，平均差异分别为-0.3和0.4。
小剂量S-氯胺酮用于食管癌根治性切除术患者的术后急性疼痛管理，可使阿片类药物用量减少40%并促进康复。
