Effectiveness of intravenous administration of a combination of sufentanil and esketamine on post-cardiac surgery pain management and depression: a randomized controlled trial.

BACKGROUND: Cardiac surgery often results in significant postoperative pain, which can lead to complications and prolonged recovery. Pain and depression are closely linked, with effective pain management potentially reducing the risk of depression. Combining sufentanil, an opioid, with esketamine, a medication with both analgesic and antidepressant effects, may improve pain control and mood in postoperative patients. While promising in other surgeries, their effects in cardiac surgery remain unclear. This study explores how sufentanil and esketamine work together to manage pain and reduce depression after cardiac surgery.

METHODS: A randomized controlled clinical trial was conducted from January 2021 to December 2023, involving 104 patients who underwent cardiac surgery. Patients [aged 61-64 years, body mass index (BMI) <30 kg/m2, American Society of Anesthesiologists (ASA) I-II, the snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender (STOP-Bang) score <3] were randomly assigned to a control group (n=52) receiving 2.5 µg/kg sufentanil or an experimental group (n=52) receiving 2.0 µg/kg sufentanil with 2 mg/kg esketamine via a central venous catheter for 48 h postoperatively. Exclusion criteria included allergies to fentanyl or etomidate, central nervous system diseases, recent opioid use, liver/kidney failure, or severe respiratory conditions. Outcome measures included patient-controlled intravenous analgesia (PCIA) pump usage, pain scores, clinical indicators, depressive symptoms, adverse events, and satisfaction levels.

RESULTS: The experimental group had significantly fewer PCIA pump button presses (2.41±0.72) than the control group (6.20±1.31) (P<0.001). Visual analog pain scores were lower in the experimental group at multiple postoperative time points (P<0.05). Hamilton Depression Rating Scale (HAMD) scores were significantly lower in the experimental group (7.52±4.24) compared to the control group (13.84±2.76) (P<0.05), as were Hamilton Anxiety Rating Scale (HAMA) scores (8.84±2.13 vs. 12.64±3.25, P<0.05). Heart rate and mean arterial pressure were higher at postoperative time points T2, T3, and T4 in the experimental group (P<0.05), but no difference was observed at T1 (P>0.05) (T1 =4 h, T2 =8 h, T3 =24 h, T4 =48 h post-surgery). Oxygen saturation showed no significant difference between groups (P>0.05). Adverse reactions occurred in 13.46% of the experimental group and 19.23% of the control group, with no statistically significant difference (P>0.05). Patient and surgeon satisfaction scores were uniformly high on a five-point scale (both groups had median =5).

CONCLUSIONS: The combined administration of sufentanil and esketamine effectively managed pain and significantly reduced depressive symptoms in post-cardiac surgery patients. The experimental group demonstrated reduced PCIA usage and improved clinical indicators. These findings provide valuable insights for enhancing postoperative recovery and addressing both pain management and psychological well-being.

TRIAL REGISTRATION: Chinese Clinical Trial Registry; identifier: ChiCTR2400092428.