Esketamine for Postoperative Anxiety After Major Abdominal Tumor Surgery: A Randomized Clinical Trial

Postoperative anxiety is common in surgical patients and may impair recovery, especially in the patients with preoperative anxiety. However, effective strategies for treating postoperative anxiety remain limited. We hypothesized that esketamine could reduce postoperative anxiety in patients with preoperative anxiety undergoing major abdominal tumor surgery.

180 patients with preoperative anxiety scheduled for major abdominal surgery were randomly assigned to either esketamine or placebo. The primary outcome was the response rate on postoperative day 3 (POD3), defined as a ≥ 50% reduction from baseline Hamilton Anxiety Rating Scale (HAMA) score. Secondary outcomes included HAMA score on POD3 and POD30, depression and quality of recovery on POD3 and POD30, sleep quality on POD1-3 and POD30.

86 patients in the esketamine group and 87 patients in the placebo group were analyzed. On POD3, the positive response rate was 39.5% in the esketamine group and 42.5% in the placebo group (risk ratio, 0.93; 95% CI, 0.65 to 1.33; P = 0.81). The secondary outcomes showed that HAMA scores were similar between groups at POD3 (median [IQR], 6 [3-10] vs 7 [4-11]; adjusted mean difference, 0; 95% CI, -2 to 1; P = 0.59) and at POD30 (5 [3-8] vs 7 [4-11]; adjusted mean difference, -1; 95% CI, -3 to 1; P = 0.28). Patients in the esketamine group also demonstrated lower scores for depressive symptoms on POD30 (median [IQR], 5 [2-8] vs 6 [3-10]; adjusted mean difference, -2; 95% CI, -3 to -1; P = 0.001).

Esketamine did not reduce anxiety in patients with preoperative anxiety undergoing major abdominal tumor surgery on POD3 and POD30.