Effect of Esketamine on Perioperative Inflammatory Factors and Postoperative Analgesic Outcomes in Patients with Obstructive Sleep Apnea Syndrome: A Randomized Controlled Trial.

PURPOSE: The effect of esketamine on perioperative inflammatory factors and postoperative analgesic outcomes in patients with Obstructive sleep apnea syndrome (OSAS) remains unclear. This trial assesses whether 0.25 mg · kg- esketamine during general anesthesia can reduce the inflammatory level and relieve postoperative pain in OSAS patients.

PATIENTS AND

METHODS

96 adult patients with OSAS underwent palatopharyngoplasty under general anesthesia was included in our research. Following anesthetic introduction, subjects were randomized to either 0.25 mg · kg- esketamine (in 20mL solution; esketamine group) or an equivalent volume of saline (Control group). The primary result was the level of IL-6 and TNF-α before the infusion of esketamine, 40min, 4h, and 24h after the esketamine infusion. Secondary outcomes was NRS scores immediately after tracheal extubation, 4h after the infusion, postoperative day 1 (POD1), postoperative day 2 (POD 2) and postoperative day 7 (POD 7).

RESULTS

The esketamine group demonstrated significantly reduced IL-6 and TNF-α levels at 40 minutes post-infusion (P<0.001) and showed lower the numerical rating scale(NRS)scores with less rescue analgesia immediately after extubation (P<0.001) compared to the control group, despite prolonged extubation and post-anesthesia care unit (PACU) stay (P<0.001). Across POD1-2, the esketamine group maintained reduced NRS scores (P<0.001) and analgesic doses (P=0.021), higher quality of recovery-15 (QoR-15) scores and patient satisfaction scores (P<0.001) relative to control group. It is important to note that the significant differences in inflammatory markers and pain scores between groups were not sustained at the 24-hour assessment and on postoperative day 7, respectively, indicating transient effects.

CONCLUSION

Intraoperative infusion of 0.25 mg·kg- esketamine provided transient suppression of inflammatory responses and reduced early postoperative pain in OSAS patients. However, these benefits were exploratory and time-limited, and must be weighed against prolonged extubation and PACU stay.