He Zibang, Wu Jin, Yang Chun, Jiang Peng
Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, Jiangsu, China.
PeerJ. 2025 Sep 16;13:e19977. doi: 10.7717/peerj.19977. eCollection 2025.
This study aimed to evaluate the effects of perioperative intravenous esketamine on the quality of postoperative recovery in adult patients.
The primary outcome was post-anesthesia care unit (PACU) stay time. Secondary outcomes included extubation time, Quality of Recovery-40 (QoR-40) and Quality of Recovery-15 (QoR-15) scores, pain scores at 24 hours postoperatively, incidence of postoperative nausea and vomiting (PONV), postoperative sleep quality, anxiety and depression, and mental side effects. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure from inception through April 20, 2023, with an update on May 18, 2024. The study was registered on PROSPERO (Registration number: CRD42023399290). Mean differences (MD) or relative risks (RR) with 95% confidence intervals (CI) were used to estimate effect sizes. Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software.
Nineteen studies involving 1,967 patients were included. No significant differences were observed between the esketamine and control groups in PACU stay time (MD = 0.99, 95% confidence interval (CI) [-2.31-4.30], = 0.56) or extubation time (MD = 1.30, 95% CI [-1.10-3.17], = 0.34). However, the esketamine group showed significantly higher postoperative QoR-40 scores (MD = 9.40, 95% CI [6.12-12.69], < 0.00001) and QoR-15 scores (MD = 7.43, 95% CI [3.97-10.88], < 0.0001) compared to the control group.
Perioperative intravenous esketamine does not significantly affect PACU stay time, extubation time, or the incidence of postoperative mental side effects. However, it can reduce pain within 24 hours after surgery, improve sleep quality, decrease the incidence of PONV, and enhance postoperative recovery as reflected by higher QoR scores.
本研究旨在评估围手术期静脉注射艾司氯胺酮对成年患者术后恢复质量的影响。
主要结局指标为麻醉后恢复室（PACU）停留时间。次要结局指标包括拔管时间、恢复质量-40（QoR-40）和恢复质量-15（QoR-15）评分、术后24小时疼痛评分、术后恶心呕吐（PONV）发生率、术后睡眠质量、焦虑和抑郁以及精神副作用。从创刊至2023年4月20日在PubMed、EMBASE、科学网、Cochrane图书馆和中国知网进行了全面的文献检索，并于2024年5月18日进行了更新。该研究已在PROSPERO注册（注册号：CRD42023399290）。采用95%置信区间（CI）的平均差（MD）或相对风险（RR）来估计效应大小。使用RevMan 5.3和Stata 16.0软件进行荟萃分析。
纳入了19项研究，共1967例患者。艾司氯胺酮组与对照组在PACU停留时间（MD = 0.99，95%置信区间（CI）[-2.31 - 4.30]，P = 0.56）或拔管时间（MD = 1.30，95% CI [-1.10 - 3.17]，P = 0.34）方面未观察到显著差异。然而，与对照组相比，艾司氯胺酮组术后QoR-40评分（MD = 9.40，95% CI [6.12 - 12.69]，P < 0.00001）和QoR-15评分（MD = 7.43，95% CI [3.97 - 10.88]，P < 0.0001）显著更高。
围手术期静脉注射艾司氯胺酮对PACU停留时间、拔管时间或术后精神副作用的发生率无显著影响。然而，它可以减轻术后24小时内的疼痛，改善睡眠质量，降低PONV的发生率，并通过更高的QoR评分反映出增强术后恢复。
