Efficacy of esketamine for chronic post-thoracotomy pain: protocol for a systematic review and meta-analysis

Introduction: Chronic post-thoracotomy pain (CPTP) is a persistent and disabling condition affecting a significant proportion of patients after thoracotomy and posing a challenge for clinicians, despite advances in surgical and pain management strategies. Esketamine, the S-enantiomer of ketamine, has emerged as a promising therapeutic agent for various pain conditions, with evidence for its effectiveness in alleviating acute and chronic pain. This systematic review and meta-analysis will be conducted to assess the efficacy of esketamine in treating CPTP, and evaluate its effectiveness in reducing pain intensity, improving functional outcomes, and reducing opioid consumption, as well as its adverse effects.

Methods and analysis: Computer-based literature retrieval in the PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and China Science and Technology Journal Database (VIP) for randomised controlled trials will be conducted from database inception to April 2024, with no restrictions on the language of publication. Eligible trials will be those focused on esketamine use to prevent and treat CPTP in adult patients; trial groups will have received esketamine and control groups will have been treated with placebo, standard treatment or other non-esketamine medications. Primary outcome measures can include the incidence of CPTP at 3 months, 6 months or 12 months postoperatively. Secondary outcome measures will encompass Visual Analogue Scale and Numerical Rating Scale Scores for rest and movement at different postoperative timepoints, the total number and effective number of patient-controlled analgesia button presses, total consumption of sufentanil, rate of rescue analgesia, and the occurrence of postoperative adverse reactions. Two researchers will independently screen the literature, evaluate its quality and extract the data. Meta-analysis will be performed on literature meeting the quality criteria using Review Manager V.5.3 software.

Ethics and dissemination: This review does not require ethical approval. On completion, the results of the review will be submitted to a peer-reviewed journal for publication and/or presented at an academic conference.

Trial registration number: PROSPERO, CRD42024526945.