- Design
- Multicentre randomised, double-blind, placebo-controlled trial
- Population
- 873 adults having video-assisted thoracoscopic lung resection
- Primary outcome
- Chronic pain at 3 months (any pain on coughing)
- Effect
- 14.7% vs 21.2%; adjusted OR 0.62 (95% CI 0.43-0.90)
Chronic pain remains common after video-assisted thoracoscopic surgery. This multicentre double-blind trial randomised 914 adults to esketamine or saline: a 0.1 mg/kg bolus at induction, 0.1 mg/kg/h during surgery and 0.015 mg/kg/h for 48 hours afterwards.
Among 873 patients analysed, chronic pain at three months (any pain on coughing at the surgical site) occurred in 14.7% with esketamine and 21.2% with saline (adjusted OR 0.62, 95% CI 0.43-0.90). A stricter post hoc definition of moderate pain pointed the same way. Esketamine also lowered pain scores and analgesic use in the first 48 hours, without more adverse events.
The primary definition counts any pain at all, which sets a low bar; the post hoc moderate-pain result is weaker evidence. Esketamine is not available everywhere, and racemic ketamine dosing does not translate directly.
Where esketamine is available, a low-dose perioperative infusion is a reasonable addition to multimodal analgesia for thoracoscopic lung resection.
- Esketamine 0.1 mg/kg bolus, 0.1 mg/kg/h in theatre and 0.015 mg/kg/h for 48 hours was the regimen tested.
- Chronic pain at three months fell from 21.2% to 14.7%.
- Early pain scores and analgesic use were also lower, with no excess adverse events.
- Consider adding it to multimodal analgesia for thoracoscopic lung resection.
- Do not convert this regimen directly to racemic ketamine doses.
Why it matters
Chronic pain after a short-stay thoracoscopic operation is often missed because patients have left the anaesthetist's care long before it shows.
Don't overread it
The primary outcome counted any pain on coughing; the moderate-pain result was defined after the trial.
The statistics, in plain English
An adjusted odds ratio of 0.62 means about 40% lower odds of chronic pain; the interval stays below 1. In absolute terms, about one patient in 15 avoided chronic pain.
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