Effects of perioperative intravenous esketamine on postoperative recovery quality in adult patients: a systematic review and meta-analysis

Abstract

Objective This study aimed to evaluate the effects of perioperative intravenous esketamine on the quality of postoperative recovery in adult patients. Methods The primary outcome was post-anesthesia care unit (PACU) stay time. Secondary outcomes included extubation time, Quality of Recovery-40 (QoR-40) and Quality of Recovery-15 (QoR-15) scores, pain scores at 24 hours postoperatively, incidence of postoperative nausea and vomiting (PONV), postoperative sleep quality, anxiety and depression, and mental side effects. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure from inception through April 20, 2023, with an update on May 18, 2024. The study was registered on PROSPERO (Registration number: CRD42023399290). Mean differences (MD) or relative risks (RR) with 95% confidence intervals (CI) were used to estimate effect sizes. Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software. Results Nineteen studies involving 1,967 patients were included. No significant differences were observed between the esketamine and control groups in PACU stay time (MD = 0.99, 95% confidence interval (CI) [−2.31–4.30], P = 0.56) or extubation time (MD = 1.30, 95% CI [−1.10–3.17], P = 0.34). However, the esketamine group showed significantly higher postoperative QoR-40 scores (MD = 9.40, 95% CI [6.12–12.69], P < 0.00001) and QoR-15 scores (MD = 7.43, 95% CI [3.97–10.88], P < 0.0001) compared to the control group. Conclusion Perioperative intravenous esketamine does not significantly affect PACU stay time, extubation time, or the incidence of postoperative mental side effects. However, it can reduce pain within 24 hours after surgery, improve sleep quality, decrease the incidence of PONV, and enhance postoperative recovery as reflected by higher QoR scores.

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