Intraoperative esketamine infusion and postoperative sleep quality after shoulder arthroscopy: a randomized...

Sleep disturbance is common after shoulder arthroscopy and may impair postoperative recovery. Whether intraoperative esketamine infusion improves postoperative sleep quality in this population remains unclear.

In this single-center, randomized, double-blind, controlled trial, adult patients with preoperative sleep disturbance undergoing shoulder arthroscopy were assigned (1:1) to receive intraoperative esketamine infusion (0.3 mg/kg/h) or placebo. The primary outcome was sleep disturbance (Athens Insomnia Scale [AIS] ≥6) on postoperative day 1 (POD1). Secondary outcomes included subjective and objective sleep parameters, pain scores, psychological outcomes, and adverse events.

Eighty patients were included. The incidence of sleep disturbance on POD1 was significantly lower in the esketamine group compared with the placebo group (5.0% vs. 27.5%; risk ratio 0.18, 95% confidence interval 0.04-0.77). Wearable-derived monitoring on POD1 showed a longer device-estimated total sleep time in the esketamine group (P < 0.001). Exploratory device-estimated sleep-stage parameters also favored the esketamine group (all P < 0.001). Subjective sleep measures also favored the esketamine group, which had lower Athens Insomnia Scale scores on POD1, POD3, and POD7 (all P < 0.05). At POD30, the PSQI score remained lower in the esketamine group than in the placebo group (5.5 (4.0-8.0) vs. 8.0 (6.0-8.3); P = 0.001).

In this single-center randomized trial, intraoperative esketamine infusion was associated with reduced early postoperative sleep disturbance in patients undergoing shoulder arthroscopy. These preliminary findings warrant confirmation in larger multicenter trials.

MR-33-26-017245 (https://www.medicalresearch.org.cn/).