Esketamine has promising anti-inflammatory effects in orthopedic surgery and plays a protective role in postoperative cognitive function and pain management
Summary & key facts
Researchers gave a low dose of esketamine through an IV before general anesthesia to 200 adults having planned orthopedic surgery. They compared 100 people who got esketamine with 100 who got a saline placebo. The esketamine group showed smaller rises in inflammatory proteins after surgery, higher levels of antibodies, less blood loss during the operation, better scores on a short mental test at 6 and 24 hours, less reported pain at 6 and 24 hours, and fewer side effects. The study suggests this low dose of esketamine may help protect thinking and reduce pain and inflammation right after orthopedic surgery, but the results come from one hospital and look only at early recovery up to about one day after surgery.
- This study randomly assigned 200 adults having elective orthopedic surgery into two groups of 100 people each.
- People in the treatment group received 0.25 mg of esketamine per kilogram of body weight through an IV before anesthesia started.
- After surgery, the esketamine group had smaller increases in two inflammatory proteins called interleukin-6 and interleukin-1 compared with the group that got saline.
- The esketamine group had higher levels of interleukin-10 after surgery, which is a protein that helps calm inflammation.
- Patients who received esketamine kept higher levels of two important antibodies, called IgM and IgG, after surgery compared with the control group.
- Blood counts were better in the esketamine group after surgery, with healthier white blood cell and platelet numbers, while hemoglobin was similar between groups.
- The esketamine group lost less blood during the operation compared with the control group.
- On a short cognitive test used to screen thinking skills, the esketamine group scored better at 6 hours and at 24 hours after surgery.
- People who got esketamine reported less pain at both 6 hours and 24 hours after surgery on a standard 0-to-10 pain scale.
- The esketamine group had a lower overall rate of recorded adverse reactions such as nausea, vomiting, dizziness, and other side effects.
Abstract
Subanesthetic doses of esketamine in elective orthopedic surgery can effectively reduce postoperative inflammatory cytokine levels, improve immunoglobulin levels, reduce intraoperative blood loss, protect postoperative cognitive function, and significantly decrease the incidence of postoperative pain and adverse reactions. These findings suggest that subanesthetic dosing of esketamine has a high level of safety and efficacy in this clinical setting.