ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1693268
This article is part of the Research TopicPerioperative Management and Clinical Challenges in Elderly Major Surgical PatientsView all articles
Impact of Esketamine and Enhanced Perioperative Care on Postoperative Pain and Recovery in Elderly Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Provisionally accepted
- The Second Affiliated Hospital of Xingtai Medical College, Xingtai, China
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Purpose: This randomized controlled trial evaluated the combined impact of an ERAS-based perioperative care strategy incorporating intravenous esketamine and bilateral abdominal nerve block, compared with traditional perioperative management, on postoperative outcomes in elderly laparoscopic cholecystectomy (LC) patients. Methods: A total of 110 elderly patients undergoing elective LC (December 2020–2021) were randomly assigned to two groups: Group A received standard perioperative care with bilateral TAP block using ropivacaine, while Group B received an ERAS-based protocol combining the same block with pre-incision intravenous esketamine (0.3 mg/kg). The primary outcome was postoperative pain intensity, assessed by the Visual Analog Scale (VAS) at 6 hours after surgery. Secondary outcomes included hemodynamic parameters (heart rate, MAP, SVV, CI), serum stress hormone levels (epinephrine and cortisol), postoperative recovery milestones (time to ambulation, oral intake, and discharge), analgesic use, and patient satisfaction. Results: Baseline characteristics were comparable between groups (P > 0.05). Postoperatively, both groups showed reductions in heart rate and elevations in mean arterial pressure (MAP), stroke volume variation (SVV), epinephrine, and cortisol levels. However, Group B exhibited significantly more favorable outcomes, including lower SVV (P = 0.011), reduced epinephrine and cortisol concentrations (P = 0.030 and P = 0.005, respectively), and higher MAP at 30 minutes post-operation (P = 0.047). Group B also demonstrated earlier ambulation, oral intake, and discharge (P < 0.001 for all), along with lower pain scores at 6–24 h (P < 0.001), reduced need for rescue analgesics (P = 0.039), and higher satisfaction (P = 0.026). No significant differences were found in cardiac index or spontaneous breathing recovery (P > 0.05). Conclusion: Esketamine combined with abdominal nerve block within an ERAS protocol improves hemodynamic stability, mitigates stress responses, enhances pain control, and accelerates recovery in elderly patients undergoing laparoscopic cholecystectomy.
Keywords: Recovery after surgery, Esketamine, Bilateral Transversus Abdominis Plane Block, laparoscopic cholecystectomy, Elderly Recovery
Received: 29 Aug 2025; Accepted: 16 Oct 2025.
Copyright: © 2025 Song, Yao, LI and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenping Jia, mazui1223@163.com
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