Comparative Effectiveness of Single-Dose Epidural Esketamine versus Hydromorphone in Thoracic and Upper Abdominal Surgery: A Randomized Trial

Purpose: This study aimed to evaluate the effectiveness of a single epidural dose of esketamine versus hydromorphone in patients undergoing abdominal and thoracic surgeries. Patients and Methods: Patients undergoing elective abdominal and thoracic surgery were randomly assigned to receive either a single epidural injection of 15 mg esketamine (Group E) or 0.5 mg hydromorphone (Group H) at the end of surgery. All patients received intravenous patient-controlled analgesia postoperatively. The primary outcome was hydromorphone consumption within 48 hours after surgery. Secondary outcomes included time to first rescue analgesia, hydromorphone consumption within 0– 24, 24– 48, and 48– 72 hours, numerical rating scale (NRS) pain scores, postoperative recovery scores, and complications. Results: In total, 205 patients were enrolled, with 186 randomly assigned to either group E (n = 93) or group H (n = 93). Hydromorphone consumption within 48 hours postoperatively was significantly higher in group E than in group H. The time to first rescue analgesia was significantly longer in group H compared to group E. Within the first 24 hours postoperatively, patients in group E required more hydromorphone than those in group H. No significant difference in hydromorphone consumption between the two groups at 24– 48 and 48– 72 hours postoperatively. The NRS scores during movement were significantly higher in group E than in group H at 3 and 6 hours postoperatively. Conclusion: Single-dose epidural esketamine for postoperative analgesia resulted in higher hydromorphone consumption and a shorter time to first rescue analgesia compared to hydromorphone. Keywords: esketamine, epidural anesthesia, postoperative analgesia, hydromorphone