Comparative Effectiveness of Single-Dose Epidural Esketamine versus Hydromorphone in Thoracic and Upper Abdominal Surgery: A Randomized Trial.

This study aimed to evaluate the effectiveness of a single epidural dose of esketamine versus hydromorphone in patients undergoing abdominal and thoracic surgeries. Patients undergoing elective abdominal and thoracic surgery were randomly assigned to receive either a single epidural injection of 15 mg esketamine (Group E) or 0.5 mg hydromorphone (Group H) at the end of surgery. All patients received intravenous patient-controlled analgesia postoperatively. The primary outcome was hydromorphone consumption within 48 hours after surgery. Secondary outcomes included time to first rescue analgesia, hydromorphone consumption within 0-24, 24-48, and 48-72 hours, numerical rating scale (NRS) pain scores, postoperative recovery scores, and complications. In total, 205 patients were enrolled, with 186 randomly assigned to either group E (n = 93) or group H (n = 93). Hydromorphone consumption within 48 hours postoperatively was significantly higher in group E than in group H. The time to first rescue analgesia was significantly longer in group H compared to group E. Within the first 24 hours postoperatively, patients in group E required more hydromorphone than those in group H. No significant difference in hydromorphone consumption between the two groups at 24-48 and 48-72 hours postoperatively. The NRS scores during movement were significantly higher in group E than in group H at 3 and 6 hours postoperatively. Single-dose epidural esketamine for postoperative analgesia resulted in higher hydromorphone consumption and a shorter time to first rescue analgesia compared to hydromorphone.