Effect of a Single Subanesthetic Dose of Esketamine on Gastrointestinal Recovery After Laparoscopic Colorectal Cancer Surgery: A Randomized, Outcome-Assessor-Blinded, Placebo-Controlled Trial
Abstract
Purpose Postoperative gastrointestinal dysfunction (POGD) and Postoperative gastrointestinal intolerance (POGI) remain a critical challenge in abdominal surgery, particularly for colorectal cancer patients undergoing laparoscopic procedures. Current evidence suggests anesthetic agents may influence gastrointestinal recovery, yet the impact of esketamine remains underexplored. This trial aimed to investigate whether intraoperative esketamine administration accelerates gastrointestinal function recovery. Methods In this single-center, randomized, outcome-assessor -blind trial, 104 patients (aged 18–75, ASA I–III) scheduled for elective laparoscopic colorectal cancer surgery were allocated to receive either intravenous esketamine (0.2 mg/kg) or saline (control) 30 minutes before surgery completion. Primary outcome was time to first flatus; secondary outcomes included I-FEED scores, defecation time, oral intake tolerance, and postoperative complications assessed within seven days after surgery. Results The esketamine group demonstrated significantly shorter time to first flatus (52 [50.25–53.75] vs 60 [58.59–61.41] hours; P < 0.001) and first defecation (87 [81.96–92.04] vs 95 [92.65–97.35] hours; P = 0.04) compared to controls. I-FEED scores were markedly lower (median 1 [0.25–2] vs 2.5 [1–3]; P < 0.001), with reduced nausea (P = 0.001) and abdominal distension duration (P < 0.001). Esketamine also improved postoperative sleep quality, but did not affect hospitalization costs or length of stay. Conclusion Intraoperative esketamine accelerates gastrointestinal function recovery after laparoscopic colorectal surgery, especially reducing postoperative gastrointestinal intolerance symptoms of nausea and distension while improving early sleep quality. However, no evident benefit was observed in reducing hospital length of stay or patient costs.