Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: A randomized controlled factorial trial

Jing-Hui Hu; Zhang-Zhen Zhong; Hai-Jing Shi; Jie Wang; Shaomu Chen; Xi-Sheng Shan; Hua-Yue Liu; Hong Liu; Lingzhong Meng; Fu-Hai Ji; Ke Peng

doi:10.1097/JS9.0000000000002060

Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: A randomized controlled factorial trial

Int J Surg. 2024 Aug 22. doi: 10.1097/JS9.0000000000002060. Online ahead of print.

Authors

Jing-Hui Hu^{1

2}, Zhang-Zhen Zhong^{1

3}, Hai-Jing Shi^{1

2}, Jie Wang³, Shaomu Chen⁴, Xi-Sheng Shan^{1

2}, Hua-Yue Liu^{1

2}, Hong Liu⁵, Lingzhong Meng⁶, Fu-Hai Ji^{1

2}, Ke Peng^{1

2}

Affiliations

¹ Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
² Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China.
³ Department of Anesthesiology, Suzhou Ninth People's Hospital, Suzhou, Jiangsu, China.
⁴ Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
⁵ Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA.
⁶ Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA.

PMID: 39172717
DOI: 10.1097/JS9.0000000000002060

Abstract

Background: Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection.

Materials and methods: This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 mL. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0.

Results: The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI, 4.0-8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI, 0.2-4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0).

Conclusions: For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.