Low-dose esketamine for postoperative pain, sleep, and hemodynamic stability in functional endoscopic sinus surgery: a retrospective cohort study

Abstract

Objective To evaluate the efficacy and safety of low-dose esketamine (0.2 mg/kg or 0.3 mg/kg) in improving postoperative pain, sleep quality, hemodynamic stability, and emotional status in functional endoscopic sinus surgery (FESS) patients. Methods This retrospective cohort study analysed 135 chronic rhinosinusitis patients (January 2021–December 2023) divided into control (normal saline, n = 45), 0.2 mg/kg esketamine (n = 45), and 0.3 mg/kg esketamine (n = 45) groups. Propensity score matching (PSM)-balanced baselines. Primary outcome: 24-hour post-operative VAS pain score. Secondary outcomes included sleep/emotion/hemodynamic indices and adverse events. Python-based statistical analyses were performed. Results After PSM, 40 patients/group were analysed. The 0.3 mg/kg (5.82 ± 1.89) and 0.2 mg/kg (6.53 ± 1.59) groups had significantly lower 24-hour VAS scores than the control group did (7.16 ± 0.93, P < 0.001), with the 0.3 mg/kg group being superior (P = 0.032). The eyesketamine group had better sleep quality (PSQI: 3.53 ± 0.69–6.31 ± 0.51 vs. 9.07 ± 1.12; P < 0.001), reduced anxiety/depression (HAM-A/HAM-D), improved resilience (CD-RISC), and less vasoactive drug use (P < 0.001). Adverse events were lower, with no increased neuropsychiatric reactions. Conclusion The use of low-dose esketamine (particularly 0.3 mg/kg) in FESS patients is associated with clinically meaningful improvements in pain control, sleep quality, emotional well-being, and hemodynamic parameters, alongside a favorable safety profile with no increase in neuropsychiatric adverse events. These findings support its consideration as a viable non-opioid analgesic adjunct in this surgical setting.