Effect of Low-dose Esketamine on Postoperative Recovery Quality in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

Purpose To investigate the effect of intraoperative low-dose esketamine infusion on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy. Patients and methods: A total of 106 female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into group P (saline group) and group S (esketamine group). Group P received induction with normal saline, propofol, sufentanil, midazolam, and rocuronium, while group S received induction with low-dose esketamine (0.25 mg/kg), propofol, sufentanil, midazolam, and rocuronium. Both groups were maintained with intravenous infusion of propofol and remifentanil. The quality of recovery (QoR-40), Numerical Rating Scale (NRS), and Pittsburgh Sleep Index (PSQI) scores were assessed at 8, 24, 48, 72 hours, 7 days, and 30 days post-surgery. Hamilton Depression Scale (HAMD) scores were evaluated at 72 hours, 7 days, and 30 days post-surgery. Intraoperative hemodynamics, remifentanil consumption, total surgical cost, inflammatory reactions, and adverse reactions were also documented. Results Both groups had similar QoR-40 scores at each time point (P > 0.05). Patients in group S had less intraoperative remifentanil use (P < 0.001), less consumption of phenylephrine (P = 0.005), fewer episodes of hypotension (P < 0.001), and shorter extubation and PACU residence times (P < 0.001). The NRS scores after extubation (P = 0.007), 8 hours (P = 0.027), and 48 hours (P = 0.016) after surgery, and the postoperative NLR (P = 0.003), and postoperative 24-h PSQI score (P = 0.024) were significantly lower in group S. The MBP was higher at T3 (P < 0.001), and the HR was faster at T1 (P = 0.005), T3 (P = 0.023), T4 (P = 0.014) and T5 (P = 0.010) in group S. Multiple linear regression analyses demonstrated that educational attainment was associated with postoperative recovery (P < 0.05). Conclusion In patients undergoing total laparoscopic hysterectomy, the use of low-dose esketamine did not affect QoR-40 scores for overall postoperative recovery. However, it resulted in improved maintenance of intraoperative hemodynamics, decreased intraoperative opioid requirements, shortened postoperative extubation and PACU dwell time, and alleviated postoperative inflammatory response and pain, without introducing additional adverse effects.