Esketamine relieves postoperative depression and pain indicators in patients undergoing laparoscopic total hysterectomy

Objective To observe the effects of esketamine on postoperative depression and pain indicators in individuals undergoing total laparoscopic hysterectomy. Methods 135 patients undegoing total laparoscopic hysterectomy were recruited and randomly allocated to three groups. Finally, a total of 127 patients were selected into the statistical analysis, with the final grouping information as follows: sufentanil group (S1, n = 44), sufentanil combined with 0.25mg/kg esketamine group (SK1, n = 42) and sufentanil combined with 0.5mg/kg esketamine group (SK2,n = 41) intraoperatively, then the SK1 and SK2 group were maintained analgesia with esketamine 1 mg/kg patient-controlled intravenous analgesia(PCIA) postoperatively. The peripheral blood serum brain-derived neurotrophic factor (BDNF) level, 5-hydroxytryptamine (5-HT) level, Hamilton Depression Scale (HAM-D) scores, visual analogue scale(VAS) scores and the number of PCIA button pressed times in perioperative period were collected. Meanwhile, the postoperative adverse effects including nausea, vomiting, dizziness, respiratory depression and hallucinations were collected and compared between the three groups. Results Compared with S1 group, the SK1 and SK2 group showed significantly higher serum BDNF and 5-HT levels at the 1th day(d1), d2 and d5 after operation (P < 0.05), and revealed even higher at d1 and d2 after operation in SK2 group(P < 0.05). The HAM-D scores at d1, d2 and d5 post operation were significantly reduced in SK1 and SK2 group (P < 0.05) compared to S1 group, and decreased even lower at d1 and d2 postoperative in SK2 group(P < 0.05), but no significant difference was found among three groups at 1 day before and the d7 after operation. Simultaneously, the VAS scores decreased significantly in SK1 and SK2 group at the 1th hour(1h), 6h, 12h, 24h, and 48h after surgery (P < 0.05), and the PCIA button pressed times were also significantly reduced in SK1 and SK2 group (P < 0.05) during the postoperative 48 hours. Furthermore, the SK1 and SK2 group showed the lower dosage of remifentanil during the surgery(P < 0.05). However, the postoperative adverse effects had no statistical differences among the three groups. Conclusion Esketamine can relieve postoperative depression and pain indicators without the increasing of adverse effects in patients undergoing total laparoscopic hysterectomy. Moreover, the 0.5 mg/kg dosage intraoperatively may have the better alleviation property of depression-related indicators. Trial registration Chinese Clinical Trial Registry (ChiCTR2200065198)