S-ketamine promotes postoperative recovery of gastrointestinal function and reduces postoperative pain in gynecological abdominal surgery patients: a randomized controlled trial

Abstract

Background This prospective randomized controlled study was designed to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery. Methods One hundred gynecological patients undergoing open abdomen surgery were randomized into an S-ketamine group (group S) or placebo group (0.9% saline; group C). Anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion in group S and with sevoflurane and remifentanil-propofol target-controlled infusion in group C. All patients were connected to patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The primary outcome was the time of first postoperative flatus, and the secondary outcome was postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded. Results The time of first postoperative flatus in group S was significantly shorter (mean ± SD, 50.3 ± 13.5 h) than that in group C (mean ± SD, 56.5 ± 14.3 h, p = 0.042). The patient’s visual analog scale (VAS) pain score 24 h after surgery at rest was significantly lower in group S than in group C (p = 0.032). There were no differences in sufentanil consumption within the first postoperative 24 h, postoperative complications related to PCIA between the two groups. Conclusions S-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain in patients undergoing open gynecological surgery. Trial registration ChiCTR2200055180. Registered on 02/01/2022. It is a secondary analysis of the same trial.

Impact of intra-operative ketamine on postoperative outcomes in abdominal surgery: a narrative review

“…Zhang et al (2023) found no postoperative delirium, oliguria, or emergence agitation in the S-ketamine group. Additionally, side effects including dizziness, nausea, vomiting, or flatulence/bloating adverse events were comparable between the S-ketamine and control groups ( 14 ).…”

“…Notably, Zhang et al (2023) found that S-ketamine improved postoperative gastrointestinal (GI) recovery, reflected by a significantly shorter time of first postoperative flatus. The mean first postoperative flatus time for the S-ketamine group (50.3 hours) was 6.2 hours earlier than in the control group (56.5 hours) ( 14 ). However, additional research is essential to further elucidate effects of ketamine on postoperative GI recovery.…”

“…Moreover, VAS scores were significantly lower after 24 hours in the groups that administered intraoperative ketamine compared to preoperative administration alone ( 13 ). Zhang et al (2023) also found a statistically significant reduction in pain scores after 24 hours ( 14 ).…”

Esketamine combined with sufentanil versus sufentanil in patient-controlled intravenous analgesia: a meta-analysis

“…Ultimately, 32 valid studies were included in this meta-analysis, including 3,709 patients ( Guo et al, 2021 ; Li, 2021 ; Lyu et al, 2021 ; Yan, 2021 ; Wang JF. et al, 2022 ; Wang N. et al, 2022 ; Cai et al, 2022 ; Chi et al, 2022 ; Wang Y. et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; He et al, 2022 ; Jiang et al, 2022 ; Li et al, 2022 ; Liang, 2022 ; Luo et al, 2022 ; Peng et al, 2022 ; Qiu et al, 2022 ; Qiu and Wang, 2022 ; Wang, 2022 ; Xu and Li, 2022 ; Zhang et al, 2022 ; Zheng et al, 2022 ; Zhou et al, 2022 ; Yang B. et al, 2023 ; Zhang et al, 2023a ; Yang SQ. et al, 2023 ; Gui et al, 2023 ; Han et al, 2023 ; Su et al, 2023 ; Wang et al, 2023 ; Xie et al, 2023 ) ( Figure 1 ).…”

“…et al, 2023 ; Gui et al, 2023 ; Han et al, 2023 ; Su et al, 2023 ; Wang et al, 2023 ; Xie et al, 2023 ) described the details of random sequence generation. Twelve studies ( Li, 2021 ; Yan, 2021 ; Chi et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; Luo et al, 2022 ; Qiu and Wang, 2022 ; Zheng et al, 2022 ; Zhang et al, 2023a ; Yang SQ. et al, 2023 ; Han et al, 2023 ; Wang et al, 2023 ) described the blinding method of participants and people and were thus considered to have a low risk of bias for this domain, while the remaining 20 studies did not describe the blinding methods and were considered to have an unclear risk of bias.…”