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.

Abstract

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). In this trial, 120 elderly patients who underwent THA or TKA were randomized to patient-controlled sufentanil analgesia (2 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) 1. Postoperative sleep disturbance (PSD) was defined as a numeric rating scale score of 6 or higher or an Athens Insomnia Scale score of 6 or higher. The secondary outcomes included the incidence of PSD on postoperative days 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. 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 postoperative days 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. Esketamine (0.72 mg kg^-1) in PCIA safely prevents PSD, improves analgesia, relieves anxiety and depression, and accelerates postoperative recovery in elderly patients who had THA or TKA.