Effect of Esketamine for Patient-Controlled Intravenous Analgesia on Postoperative Sleep Disturbance in the Elderly After Total Hip or Knee Arthroplasty: A Prospective, Randomized, Double-Blind, and Controlled Trial.

Background: Postoperative sleep disturbance (PSD) commonly affects elderly patients, impairing recovery. This study investigated the effect of esketamine for patient-controlled intravenous analgesia (PCIA) on PSD in elderly patients who had total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods: In this trial, 120 elderly patients who underwent THA or TKA were randomized to patient-controlled sufentanil analgesia (two μg kg-1 in normal saline to 100 ml) or a supplement (esketamine 0.72 mg kg-1). The primary outcome was the incidence of PSD on postoperative day (POD) one. A PSD was defined as a numeric rating scale (NRS) score of 6 or higher or an Athens Insomnia Scale (AIS) score of 6 or higher. The secondary outcomes included the incidence of PSD on postoperative days (PODs) two, three, and seven; postoperative subjective sleep quality; anxiety and depression; cognitive function; the number of PCIA attempts; rescue analgesics within 48 hours, postoperative delirium, and quality of recovery. Also, nausea and vomiting; and other adverse events were compared.

Results: There were 112 patients included in the per-protocol analysis. The incidence of PSD was lower in the esketamine group compared to the sufentanil group on POD one (P = 0.002), POD two (P = 0.018), and POD three (P = 0.025). Compared with the sufentanil group, the esketamine group had lower anxiety and depression scores on PODs one, two, and three (P < 0.05), better postoperative recovery (P < 0.05), and fewer rescue analgesics within 48 hours (P = 0.016). There were no significant differences in postoperative cognitive function (P > 0.05), incidence of postoperative delirium (P > 0.05), and adverse events between the two groups.

Conclusions: Esketamine (0.72 mg kg-1) as a supplement in PCIA safely prevents the incidence of PSD, improves analgesia, relieves anxiety and depression, and accelerates postoperative recovery in elderly patients who had THA or TKA. Background: ChiCTR2400085319.