Intravenous Esketamine Versus Erector Spinae Plane Block for Postoperative Recovery Quality Following Video-Assisted...

Area of Science:

• Anesthesiology and Pain Management
• Thoracic Surgery
• Pharmacology

Background:

• Optimizing postoperative recovery and pain management after video-assisted thoracoscopic surgery (VATS) is crucial.
• Erector spinae plane block (ESPB) is a regional anesthesia technique used for thoracic surgery pain.
• Intravenous esketamine is an option for analgesia and has known psychotropic effects.

Purpose of the Study:

• To compare the non-inferiority of intravenous esketamine versus ESPB in terms of postoperative recovery quality and analgesic efficacy in VATS patients.
• To evaluate pain scores, recovery quality (QoR-15), anxiety/depression (HADS), and hemodynamic stability.

Main Methods:

• A randomized controlled non-inferiority trial involving 112 patients undergoing VATS.
• Patients received either intravenous esketamine with a sham ESPB or an active ESPB with intravenous saline.
• Outcomes measured included Quality of Recovery-15 (QoR-15) scores, pain scores, HADS scores, and hemodynamic parameters.

Main Results:

• Intravenous esketamine met the non-inferiority criterion for QoR-15 scores on postoperative days 1 and 2 compared to ESPB.
• The ESPB group demonstrated significantly lower pain scores during coughing at 4 and 8 hours postoperatively.
• The esketamine group exhibited lower Hospital Anxiety and Depression Scale (HADS) scores and reduced incidence of hypotension.

Conclusions:

• Intravenous esketamine provides postoperative recovery quality non-inferior to ESPB following VATS, largely due to its positive impact on mood.
• Esketamine's anxiolytic and antidepressant effects can compensate for its less potent early analgesic properties compared to ESPB.
• Esketamine is suggested as a rescue option or analgesic adjunct, rather than a direct substitute for ESPB, particularly when ESPB is not feasible.