Effect of intravenous esketamine on postoperative sleep disturbance, anxiety, and depression in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial

The population of elderly individuals undergoing surgical procedures is increasing, necessitating effective postoperative management strategies. Postoperative sleep disturbance, anxiety, and depression are significant contributors to overall recovery in this demographic, especially following laparoscopic abdominal surgery. This study included 200 records of elderly patients undergoing laparoscopic abdominal surgery. Patients were divided into an esketamine group, receiving intravenous esketamine, and a control group, receiving normal saline. Parameters such as surgery and anesthesia duration, fluid volume, blood loss, urine output, sleep disturbance, anxiety, depression, pain assessment, and adverse events were compared between the two groups. The esketamine group had significantly fewer postoperative sleep disturbances, lower anxiety and depression scores on days 1 and 3, and lower Visual Analog Scale (VAS) scores compared to the control group (P < 0.05). They also required less rescue analgesia, used fewer opioids, and consumed fewer non-opioid analgesics (P < 0.05). However, the esketamine group experienced a higher incidence of dissociative symptoms (P < 0.05), while other adverse events were similar between the groups. Overall, esketamine improved pain management and reduced anxiety and depression but increased the risk of dissociative symptoms. Intravenous esketamine administration in elderly patients undergoing laparoscopic abdominal surgery was associated with reduced postoperative sleep disturbance, lower postoperative pain scores, lower anxiety and depression scores, decreased rescue analgesia requirements, reduced opioid consumption, and a lower use of non-opioid analgesic medications. This clinical study was registered at Chinese Clinical Trial Registry (ChiCTR, ChiCTR2400087795).