Low-dose esketamine for postoperative fatigue after gynecological laparoscopic surgery: a randomized controlled trial.

Authors

Ge Sun, Wentao Lin, Yujin Peng, Zhuming Liang, Haiming Liao, Jun Zhou, Fuhu Song

Published in

BMC anesthesiology. Jun 26, 2026. Epub Jun 26, 2026.

Abstract

Postoperative fatigue is a prevalent complication delaying early recovery after gynecological laparoscopic surgery, with no proven effective interventions. To investigate the effect of continuous intraoperative low-dose esketamine on postoperative fatigue in patients undergoing gynecological laparoscopic surgery.
This single-center, double-blind, randomized placebo-controlled trial enrolled 116 elective gynecological laparoscopic surgery patients, randomly assigned 1:1 to the esketamine group (0.2 mg·kg⁻¹·h⁻¹ esketamine infusion during surgery, n = 58) or control group (equal volume normal saline, n = 58). The primary outcome was the incidence of postoperative fatigue on postoperative day 1 (POD1, Chalder Fatigue Scale score ≥ 4). Secondary outcomes included Chalder Fatigue Scale scores, 15-item Quality of Recovery (QoR-15) scores, Visual Analogue Scale (VAS) pain scores, perioperative drug consumption, and safety events.
In the primary intention-to-treat analysis, the incidence of POD1 postoperative fatigue was 23.3% (14/60) in the esketamine group and 40.0% (24/60) in the control group (risk difference - 16.7%, OR = 0.46, 95% CI 0.21-1.01, P = 0.050). Esketamine group had significantly lower POD1 fatigue scores, better recovery quality and pain control on POD1 and POD3, reduced intraoperative sufentanil and ephedrine consumption, (all P < 0.05). No significant differences in adverse events were observed between groups (all P > 0.05).
Intraoperative low-dose esketamine shows a favorable effect on reducing postoperative fatigue, and significantly improves recovery quality and analgesia, without increasing adverse events in patients undergoing gynecological laparoscopic surgery. The primary ITT analysis shows a borderline significant reduction in fatigue incidence, which is supported by a statistically significant result in the per-protocol sensitivity analysis.
This study was prospectively registered at the Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn/showproj.html?proj=290957), with the clinical trial registration number ChiCTR2500112382, and the registration date is November 13, 2025.

PMID:
42363112
Bibliographic data and abstract were imported from PubMed on 27 Jun 2026.

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