4. Discussion
Postoperative pain, knee arthroplasty, pain, dissociative
ADVERSE REACTIONS, RESPIRATORY DEPRESSION
As anesthesia safety and surgical techniques have improved, the assessment of quality of postoperative recovery has become the primary endpoint outcome in research. In this prospective, RCT, we discovered that intravenous low-dose esketamine combined with general anesthesia improved the early postoperative quality of recovery from the patients’ perspective in patients undergoing laparoscopic radical resection of CRC using the QoR-15 score as a patient-centered primary outcome. This finding has significant implications for the selection of anesthesia methods and drugs in patients undergoing laparoscopic radical resection of CRC.Esketamine, the S(+)-isomer of ketamine, is a chiral cyclohexanone with stronger sedative and analgesic effects and is also a dissociative anesthetic; It mainly acts on NMDA receptors by binding to the phencyhexidine site, non-competitively inhibiting the activation of the receptor by glutamate, thereby weakening neuronal activity and producing sedative, analgesic and anesthetic effects [Stark et al. [Cheng X et al. [Postoperative pain and delayed recovery of intestinal function are important factors influencing patients’ ability to recover quickly after surgery [Opioids are known cause respiratory depression [A previous study found that low-dose esketamine can increase hemodynamic stability during induction of anesthesia in elderly patients undergoing total knee arthroplasty [There were some limitations in this study. Firstly, the patients in our study were ASA Ⅰ or Ⅱ, relatively healthy, and had an upper age limit. Further research should be conducted on elderly patients with ASA Ⅲ or Ⅳ to confirm the findings’ generalizability. Secondly, we only looked at the effect of esketamine on early recovery quality, and patients were not followed up for a long time after surgery. A previous study found a link between the quality of recovery in the hospital and the quality of life three months after surgery [In conclusion, intraoperative intravenous low-dose esketamine can improve the early postoperative quality of recovery, reduce pain scores and opioid consumption in patients undergoing laparoscopic radical resection of CRC without increasing adverse reactions. Future clinical trials with other types of surgery will be required to investigate the long-term effects of esketamine on patients’ recovery.