CLINICAL TRIAL article
Front. Pharmacol.
Sec. Neuropharmacology
Esketamine-Based PCIA Combined with Intercostal Nerve Block for Acute Pain After Lobectomy: A Randomized Controlled Trial
Meiyan Zhou 1
Yu Qi 1
Fan Zhou 2,1
Hui Wu 1,2
Jiao Chen 1
Long Wang 1
Liwei Wang 1
1. Xuzhou Central Hospital, Xuzhou, China
2. Xuzhou Medical University School of Anesthesiology, Xuzhou, China
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Abstract
ABSTRACT 1 Objective: To evaluate outcomes of different doses of esketamine in postoperative 2 patient-controlled intravenous analgesia (PCIA) combined with preoperative intercostal 3 nerve block(ICNB) analgesia protocol for acute postoperative pain (APP) relief in patients 4 undergoing thoracoscopic lobectomy. 5 Materials and methods: A total of 360 patients scheduled for thoracoscopic lobectomy at 6 Xuzhou Central Hospital between October, 2021 and July, 2023 were enrolled and 7 randomly assigned into three groups using the random envelope method. Before anesthesia 8 induction, all patients received ICNB, followed by general anesthesia. Group C received 9 PCIA using sufentanil at 0.03 µg/kg/h, Group K1 received a low dose of esketamine at 10 0.015 mg/kg/h in PCIA, and Group K2 received a moderate dose of esketamine at 0.03 11 mg/kg/h in PCIA. Numerical rating scale (NRS) pain scores were recorded at 2, 4, 24, 48, 12 and 72 hours postoperatively. The incidence of APP within 72 hours post-surgery, the 13 requirement for rescue analgesia and the occurrence of adverse reactions, were assessed 14 and recorded for the three groups. 15 Results: There were significantly lower NRS scores in Group K2 at 2, 4, 24, 48, and 72 16 hours postoperatively, compared to Groups C and K1 (P<0.01). However, there were no 17 statistically significant differences in NRS scores between Group C and Group K1 (P>0.05). 18 3 The incidence of APP within 72 hours postoperatively was significantly lower in Group K2, 19 compared to Group C and Group K1 (P<0.05). Additionally, Group C exhibited a 20 significantly higher the incidence of postoperative nausea and vomiting (PONV) than the 21 other two groups (P<0.05). Group K2 demonstrated superior postoperative analgesic 22 efficacy, including reduced rescue analgesia needs and lower opioid consumption, without 23 affecting hospital stay length compared to Groups C and K1. 24 Conclusions: A dose of 0.03 mg/kg/h esketamine in PCIA combined with preoperative 25 ICNB significantly alleviates APP in patients undergoing thoracoscopic lobectomy, 26 reducing resting pain scores by approximately 30% at 24 hours compared to 27 sufentanil-based analgesia.
Summary
Keywords
Esketamine, Intercostal nerve block, Lobectomy, opioid-sparing analgesia, Postoperative pain
Received
14 November 2025
Accepted
20 February 2026
Copyright
© 2026 Zhou, Qi, Zhou, Wu, Chen, Wang and Wang. 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: Liwei Wang
Disclaimer
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