Effects of low-dose esketamine on early quality of recovery following minimally invasive esophagectomy: a multicenter, randomized controlled study.

TL;DR

In patients undergoing minimally invasive esophagectomy, intraoperative low-dose esketamine significantly improved Quality of Recovery (QoR-15) scores on postoperative days 2 and 3, while reducing postoperative pain, anxiety, and depression compared to placebo.

Key findings

• Low-dose esketamine infusion (0.25 mg/kg loading, 0.125 mg/kg/h continuous) significantly improved QoR-15 scores on POD 2 (116.9 vs. 110.2) and POD 3 (123.6 vs. 116.8) versus placebo
• Esketamine recipients demonstrated lower Hospital Anxiety and Depression Scale scores (both anxiety and depression subscales) on POD 1-3 compared to placebo
• Esketamine group reported significantly lower numeric rating scale pain scores at rest and with movement, and lower Brief Pain Inventory scores for pain severity and interference
• No significant safety differences were observed between esketamine and placebo groups

Why this matters at the bedside

This multicenter RCT demonstrates that perioperative low-dose esketamine is an effective adjunct for improving early postoperative recovery quality in major esophageal surgery, with benefits extending to pain control and mood outcomes without safety concerns.