Low-dose esketamine at the end of colorectal surgery shortened time to first flatus

Design

Single-centre, randomised, assessor-blinded, placebo-controlled trial

Population

104 adults having elective laparoscopic colorectal cancer surgery

Primary outcome

Time to first flatus

Effect

Median 52 vs 60 hours; first defecation 87 vs 95 hours

Gastrointestinal dysfunction after abdominal surgery delays eating, causes nausea and distension, and can prolong recovery. In this single-centre trial in China, 104 adults having elective laparoscopic colorectal cancer surgery were randomised to intravenous esketamine 0.2 mg/kg or saline 30 minutes before the end of surgery. Outcome assessors were blinded.

Median time to first flatus was 52 hours with esketamine against 60 with saline, and first defecation 87 against 95 hours. Gastrointestinal intolerance scores (I-FEED) were lower, with less nausea and shorter distension, and early sleep quality was better. Length of stay and hospital costs did not change.

The benefit is modest — about eight hours — and the trial is single-centre with an opioid-sparing mechanism as the likely explanation. Within an enhanced-recovery pathway, a low dose of esketamine or ketamine is worth considering as part of multimodal analgesia, but it is not yet a reason to change protocols on its own. Esketamine availability for intravenous anaesthetic use varies, including in India.

• Consider low-dose esketamine or ketamine as part of opioid-sparing multimodal analgesia in colorectal surgery.
• Expect a modest gain in bowel recovery, not a shorter stay.
• Keep core enhanced-recovery measures: early feeding, mobilisation and minimal opioids.
• Watch for psychotomimetic effects, though the trial dose was low.
• Use local anaesthetic protocols; this single trial does not set a standard dose.

Why it matters

Postoperative ileus is often treated as unavoidable, but anaesthetic choices at the end of surgery may shift it.

Don't overread it

A single-centre trial with no change in length of stay cannot establish esketamine as standard enhanced-recovery care.

The statistics, in plain English

The median difference of about 8 hours to first flatus is statistically clear, but whether it matters depends on whether it changes eating, comfort or discharge — and discharge did not change.

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