Perioperative esketamine combined with butorphanol versus butorphanol alone for pain management following video-assisted lobectomy: a randomized controlled trial

Background: The analgesic efficacy of esketamine combined with butorphanol in thoracoscopic surgery remains unclear.

Aim: This study explored the effects of perioperative esketamine combined with butorphanol versus butorphanol alone on acute and chronic postoperative pain in patients who underwent video-assisted lobectomy.

Method: A total of 181 patients were enrolled, with 90 in the esketamine-butorphanol group (Group BK) receiving intraoperative esketamine infusion and postoperative patient-controlled intravenous analgesia (PCIA) (esketamine 1.5 mg/kg, butorphanol 0.15 mg/kg, azasetron 20 mg). The remaining 91 patients in the butorphanol group (Group B) received normal saline and PCIA with butorphanol (0.15 mg/kg) and azasetron (20 mg). Primary endpoints included Visual Analog Scale (VAS) scores in the first week and chronic pain incidence at three months. Secondary endpoints included intraoperative vital signs, morphine consumption, postoperative adverse events, and 15-item Quality of Recovery-15 (QoR-15) scores.

Results: Group BK demonstrated significantly lower VAS scores within 48 h at rest and within 24 h during coughing postoperatively (P < 0.001). However, no significant differences were observed in VAS scores [(Group B, 5 (0-12)) vs. (Group BK, 5 (0-9)), P = 0.517] or chronic pain incidence [(Group B, 34.1%) vs. (Group BK, 23.3%), P = 0.111] between the two groups at the three-month follow-up. Patients in Group BK exhibited improved postoperative stability of vital signs and higher QoR-15 scores.

Conclusion: Perioperative administration of esketamine significantly mitigates acute postoperative pain and enhances recovery quality in patients undergoing video-assisted lung resection.

Trial registration: This trial protocol is registered with ClinicalTrials.gov (NCT06398834, date: 2024-05-01).