Effect of S-ketamine on Postoperative Quality of Recovery in Patients Undergoing Video-Assisted Thoracic Surgery

Abstract

Objectives: S-ketamine is associated with effective postoperative analgesia and enhanced quality of recovery (QoR). The study aimed to investigate the effect of perioperative S-ketamine on postoperative quality of recovery in patients undergoing video-assisted thoracic surgery (VATS).

Design: A prospective, randomized, double-blinded, placebo-controlled trial.

Setting: Single institution, tertiary university hospital.

Participants: Eighty adult patients aged 18-to-65 undergoing VATS were eligible for participation.

Interventions: Patients enrolled in this study were randomized to receive either S-ketamine (a bolus of 0.25 mg/kg, followed by an infusion of 0.125 mg/kg/h until 15 minutes before the end of the surgical procedure), or identical volumes and rates of 0.9% saline.

Measurements and main results: Postoperative quality of recovery was measured with QoR-40 score 48 hours after surgery. The postoperative pain was assessed postoperatively using the numeric rating scale at 0.5, 6, 24, and 48 hours. Hospital Anxiety and Depression Scale Depression subscale (HADS-D) scores and other secondary outcomes also were recorded. The final analysis included 77 patients. The global QoR-40 score at 48 hours postoperatively was higher in the S-ketamine group compared with the saline group (median [interquartile range]: 181.5 [178-184] v 174.5 [169-177]), estimated median difference 7 (95% confidence interval 5-10, p < 0.001). Patients who received S-ketamine treatment had lower pain scores at rest (p = 0.017 and p = 0.006, respectively) and coughing (p < 0.001 and p = 0.007, respectively) at 24 and 48 hours postoperatively than those who received saline treatment. The requirement and consumption of opioid for rescue analgesic were lower in the S-ketamine (p = 0.045 and p = 0.047, respectively). Compared with the saline group, S-ketamine reduced HADS-D scores (p = 0.003) at 48 hours after surgery.

Conclusions: The present study's findings suggested that perioperative S-ketamine enhanced the quality of recovery in patients undergoing VATS. S-ketamine also improved postoperative analgesia and postoperative depression.

Keywords: Postoperative analgesia; Postoperative depression; Quality of recovery; S-ketamine; Video-assisted thoracic surgery.