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The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial

Mogianos, Krister LU orcid ; Holgersson, Josefine ; Undén, Johan LU and Persson, Anna KM LU orcid (2025) In Journal of Clinical Anesthesia 108. p.1-8
Abstract
Objective
To evaluate if adding esketamine and clonidine has positive effects on postoperative pain, postoperative nausea and vomiting, and quality of recovery in patients who are at high risk for postoperative pain.
Design
Patient- and assessor-blinded, superiority, randomised controlled trial.
Setting
Single centre between 2022 and 2024.
Patients
125 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as high risk of pain, based on perceived pain associated with venous cannulation.
Intervention
Patients were randomised to either an anaesthesia protocol, including an intravenous bolus of esketamine (0.25 mg.kg−1) after induction and clonidine (1 μg.kg−1) during... (More)
Objective
To evaluate if adding esketamine and clonidine has positive effects on postoperative pain, postoperative nausea and vomiting, and quality of recovery in patients who are at high risk for postoperative pain.
Design
Patient- and assessor-blinded, superiority, randomised controlled trial.
Setting
Single centre between 2022 and 2024.
Patients
125 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as high risk of pain, based on perceived pain associated with venous cannulation.
Intervention
Patients were randomised to either an anaesthesia protocol, including an intravenous bolus of esketamine (0.25 mg.kg−1) after induction and clonidine (1 μg.kg−1) during maintenance phase (EC), or standard of care (SOC) no esketamine or clonidine included.
Measurements
Primary outcome: worst pain intensity in the PACU. Secondary outcomes: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.
Results
Worst pain scores in the PACU were 5.7 in the EC group and 5.5 in SOC group (P = 0.78). After 24 h, no difference in postoperative pain (rest; 5.8 vs 6.1, P = 0.35, movement; 6.1 vs 6.2, P = 0.68), postoperative recovery (P = 0.92) or PONV (P = 0.80) was found. Proportion of patients with NRS ≥ 4 in the PACU was 50 % vs 48 % (P = 0.55) and at 24 h 73 % vs 81 % at rest (P = 0.27) and 76 % vs 81 % during movement (P = 0.50). Rescue opioids in the PACU were similar (5.9 mg vs 6.6 mg, P = 0.47). There were no differences in persistent pain at 3 or 6 months at rest (P = 0.72, P = 0.12) or movement (P = 0.48, P = 0.18).
Conclusion
Adding esketamine and clonidine, as an individualised multimodal anaesthesia strategy, did not influence acute or persistent postoperative pain, early recovery, need of rescue opioids or PONV in patients, who were assessed as high risk for APOP. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Clinical Anesthesia
volume
108
article number
112059
pages
1 - 8
publisher
Elsevier
external identifiers
  • pmid:41187665
ISSN
1873-4529
DOI
10.1016/j.jclinane.2025.112059
language
English
LU publication?
yes
id
5c3b1fca-5bc5-4078-9e12-f6c985188165
date added to LUP
2025-11-04 17:36:24
date last changed
2025-11-06 03:00:08
@article{5c3b1fca-5bc5-4078-9e12-f6c985188165,
  abstract     = {{Objective<br/>To evaluate if adding esketamine and clonidine has positive effects on postoperative pain, postoperative nausea and vomiting, and quality of recovery in patients who are at high risk for postoperative pain.<br/>Design<br/>Patient- and assessor-blinded, superiority, randomised controlled trial.<br/>Setting<br/>Single centre between 2022 and 2024.<br/>Patients<br/>125 adult patients, ASA I – II, planned for elective laparoscopic surgery and risk-classified as high risk of pain, based on perceived pain associated with venous cannulation.<br/>Intervention<br/>Patients were randomised to either an anaesthesia protocol, including an intravenous bolus of esketamine (0.25 mg.kg−1) after induction and clonidine (1 μg.kg−1) during maintenance phase (EC), or standard of care (SOC) no esketamine or clonidine included.<br/>Measurements<br/>Primary outcome: worst pain intensity in the PACU. Secondary outcomes: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.<br/>Results<br/>Worst pain scores in the PACU were 5.7 in the EC group and 5.5 in SOC group (P = 0.78). After 24 h, no difference in postoperative pain (rest; 5.8 vs 6.1, P = 0.35, movement; 6.1 vs 6.2, P = 0.68), postoperative recovery (P = 0.92) or PONV (P = 0.80) was found. Proportion of patients with NRS ≥ 4 in the PACU was 50 % vs 48 % (P = 0.55) and at 24 h 73 % vs 81 % at rest (P = 0.27) and 76 % vs 81 % during movement (P = 0.50). Rescue opioids in the PACU were similar (5.9 mg vs 6.6 mg, P = 0.47). There were no differences in persistent pain at 3 or 6 months at rest (P = 0.72, P = 0.12) or movement (P = 0.48, P = 0.18).<br/>Conclusion<br/>Adding esketamine and clonidine, as an individualised multimodal anaesthesia strategy, did not influence acute or persistent postoperative pain, early recovery, need of rescue opioids or PONV in patients, who were assessed as high risk for APOP.}},
  author       = {{Mogianos, Krister and Holgersson, Josefine and Undén, Johan and Persson, Anna KM}},
  issn         = {{1873-4529}},
  language     = {{eng}},
  pages        = {{1--8}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Clinical Anesthesia}},
  title        = {{The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial}},
  url          = {{http://dx.doi.org/10.1016/j.jclinane.2025.112059}},
  doi          = {{10.1016/j.jclinane.2025.112059}},
  volume       = {{108}},
  year         = {{2025}},
}