Esketamine Safe, Effective for Treating Postoperative Pain
Researchers investigate the effects of subanesthetic doses of esketamine for the treatment of pain and cognition in patients undergoing surgery.
Subanesthetic doses of esketamine (Spravato) showed improvements in pain and decreased adverse events for patients undergoing elective orthopedic surgery, according to data published in the American Journal of Translational Research.1 Based on study results and the medication’s anti-inflammatory effects, researchers suggested the safe and effective use of esketamine in postoperative settings.
“Elective orthopedic surgery plays a crucial role in the field of surgery, with postoperative recovery and prognosis directly impacting the patient’s quality of life,” they wrote. “However, the surgical procedure itself is inherently traumatic and often triggers the activation of the body’s inflammatory response. This inflammatory reaction not only increases the risk of postoperative complications but also negatively affects immune function and cognitive abilities.”
For those undergoing elective orthopedic surgery, experts have worked to determine the best processes available for maintaining a high quality of life amongst patients. While postoperative complications can include those that impact cognition, issues of postoperative pain have persisted as researchers explore the best treatment options for individuals with pain after hospital discharge.
Researchers wanted to investigate esketamine and how its use can improve overall quality of life among patients undergoing elective orthopedic surgery. | image credit: เลิศลักษณ์ ทิพชัย / stock.adobe.com
READ MORE: FDA Approves Spravato as Monotherapy for Major Depressive Disorder
A study published in Pain Reports found that postoperative pain after hospital discharge is common, with researchers stating that 1 in 3 adults experience moderate-to-severe pain on their first day home after surgery. They also found that participants’ pain increased following hospital discharges, with reports of pain among the study population increasing over 20% by day 14.2
“Previous studies have demonstrated that low-dose esketamine can modulate immune responses and reduce inflammatory cytokine levels, thereby decreasing the incidence of postoperative complications,” continued the authors.1 “However, there is a lack of systematic research on the effects of subanesthetic doses of esketamine on serum inflammatory cytokine levels and other related physiological indicators in patients undergoing elective orthopedic surgery.”
Researchers wanted to further investigate the anti-inflammatory effects of esketamine and how its use can improve overall quality of life among patients undergoing elective orthopedic surgery. They included a total of 200 patients scheduled for elective orthopedic surgery from November 2023 to March 2024. Participants were separated evenly into an esketamine or control group and were between 18 and 89 years old.
Overall, researchers aimed to understand esketamine’s impact on postoperative serum inflammatory cytokine levels, immunoglobulin levels, complete blood count parameters, intraoperative blood loss, cognitive function, and the incidence of adverse reactions in patients undergoing elective orthopedic surgery.1
For pain-related outcomes explored in the study, the esketamine group reported significantly fewer adverse reactions and lower pain scores when compared with the control group. Furthermore, esketamine was found to significantly reduce postoperative inflammatory cytokine levels, improve immunoglobulin levels, reduce intraoperative blood loss, and protect postoperative cognitive function.
“This analgesic effect of esketamine is likely due to its ability to inhibit the release of postoperative inflammatory cytokines such as IL-6 and IL-1, thereby reducing inflammation-mediated pain responses. Additionally, the elevated levels of IL-10 observed in the observation group may have contributed to both anti-inflammatory and analgesic effects, further alleviating postoperative pain,” they continued.
With the efficacy and safety of low-dose esketamine, researchers are looking to this newly approved therapy for improving overall quality of life among patients undergoing surgery. The brand-name version of esketamine was approved for depression in 2019.3 While not yet approved solely for the treatment of pain in individuals undergoing surgery, its promising use for improving cognition may lead to further investigations regarding its treatment of pain.
“These findings suggest that subanesthetic dosing of esketamine has a high level of safety and efficacy in this clinical setting,” they concluded.1
READ MORE: Pain Management Resource Center
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