Effect of opioid sparing anesthesia with esketamine on PONV in laparoscopic sleeve gastrectomy randomized trial.

Postoperative nausea and vomiting (PONV) remains highly prevalent in laparoscopic sleeve gastrectomy (LSG), with intraoperative opioid use being a key contributing factor. We conducted a prospective, double-blind, randomized trial to compare esketamine-based opioid-sparing anesthesia (OSA) to opioid-based anesthesia in adults undergoing LSG, The primary outcome was the incidence of PONV within 48 h postoperatively. OSA was associated with a significant reduction in the overall incidence of PONV within 48 h, while maintaining comparable analgesic efficacy or postoperative recovery. Additionally, OSA showed clinically significant reductions in both PONV incidence within the first 24 h and severity specifically during the 6-24-h period. Results suggest that OSA is an effective strategy for mitigating PONV following LSG.