The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial

Jiangning Xu; Jin Jian; Yunyun Zhang; Jingxiang Wu; Yuwei Qiu

doi:10.3389/fmed.2024.1344160

The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial

Front Med (Lausanne). 2024 Apr 9:11:1344160. doi: 10.3389/fmed.2024.1344160. eCollection 2024.

Authors

Jiangning Xu^#¹, Jin Jian^#^{1

2}, Yunyun Zhang¹, Jingxiang Wu^{1

3}, Yuwei Qiu^{1

3}

Affiliations

¹ Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
² Department of Anesthesiology, The People's Hospital of YuBei District, Chongqing, China.
³ Outcomes Research Consortium, Cleveland, OH, United States.

^# Contributed equally.

Abstract

Background: Whether nasal administration of esketamine can provide effective analgesia is unclear in patients with acute pain after preoperative CT-guided needle localization.

Methods: In this double-blind, randomized, placebo-controlled trial, patients were assigned to receive either nasal administration of esketamine (0.3 mg/kg or 0.5 mg/kg) or saline (identical in appearance to esketamine) when they had visual analog scale (VAS) pain scores >3/10 during deep breathing after preoperative CT-guided needle localization. The primary outcome was the percentage of patients with satisfactory pain relief, which was defined as VAS pain scores ≤3/10 measured 15 min after intranasal of esketamine or saline. Secondary outcomes included VAS measured following esketamine or saline, the incidence and cumulative dose of rescue hydromorphone use, and related adverse events.

Results: A total of 90 patients were included in the final analysis. Following intranasal treatment, the percentage of patients with satisfactory pain relief was 16.7% (5/30) in the saline group, 56.7% (17/30) in the 0.3 mg/kg esketamine group, and 53.3% (16/30) in the 0.5 mg/kg esketamine group (p = 0.002). The median VAS during deep breathing was less after the intranasal administration of esketamine {median (IQR), 3 (3, 5) in 0.3 mg/kg or 0.5 mg/kg esketamine compared to the saline group [5 (4, 6)], p = 0.009}. The incidence of rescue hydromorphone use was detected less in the esketamine group compared to the saline group (43.3% in the 0.3 mg/kg esketamine group, 36.7% in the 0.5 mg/kg esketamine group, and 73.3% in the saline group, p = 0.010). The adverse events were similar among the three groups (p > 0.05).

Conclusion: Intranasal administration of esketamine is easier and more effective in alleviating acute pain in patients after preoperative CT-guided needle localization without significant adverse effects.

Keywords: analgesia; localization; pain; pulmonary nodules; video-assisted thoracoscopic surgery.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the funding of the Shanghai Municipal Commission of Health grant 202040200. The funders had no role in the study design, data collection, data analysis, interpretation of the data, or preparation of the manuscript.