One dose of esketamine before closure and earlier bowel recovery after laparoscopic colorectal surgery

Design

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

Population

104 adults having elective laparoscopic colorectal cancer surgery

Primary outcome

Time to first flatus

Effect

52 hours vs 60 hours (P < 0.001); first defecation 87 vs 95 hours (P = 0.04)

This single-centre, outcome-assessor-blinded trial randomised 104 patients aged 18 to 75 (ASA I to III) having elective laparoscopic colorectal cancer surgery. They received intravenous esketamine 0.2 mg/kg or saline 30 minutes before the end of surgery. The primary outcome was time to first flatus.

First flatus came at a median of 52 hours with esketamine against 60 hours with saline (P < 0.001), and first defecation at 87 against 95 hours (P = 0.04). Gastrointestinal intolerance scores (I-FEED) were lower (median 1 against 2.5), with less nausea and a shorter spell of distension. Sleep quality was better. Length of stay and hospital costs did not differ.

The benefit is a matter of hours, not days, and it did not shorten admission. Because the trial was at one centre and only the outcome assessors were blinded, it supports further trials rather than routine use. Check that esketamine is available and licensed where you work.

• Earlier first flatus (about 8 hours) was the main gain; length of stay did not change.
• Consider discussing a low-dose ketamine-type adjunct with your anaesthetist as part of recovery pathways.
• Record time to flatus and tolerance of diet consistently if you audit recovery.
• Do not rely on this alone to discharge earlier.
• Check local availability: esketamine is not a standard agent in every Indian hospital.

Why it matters

It points to an anaesthetic drug as something that might shape bowel recovery, a target usually left to surgical technique and diet.

Don't overread it

A single-centre trial without a stay or cost benefit does not support routine esketamine use.

The statistics, in plain English

A very small P value shows the difference was unlikely to be chance, not that it is large. Eight hours to first flatus is modest. The trial reported medians with narrow bands rather than a confidence interval for the difference, so the precision of the effect cannot be judged from the abstract.

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