Esketamine Applications in Postoperative Management
Summary
Esketamine, the S-enantiomer of ketamine, has emerged as a versatile agent in the management of postoperative pain and mood disturbances. Its pharmacological profile combines potent analgesia with rapid antidepressant effects, mediated primarily through antagonism of N-methyl-D-aspartate (NMDA) receptors and downstream modulation of neurotrophic pathways. In perioperative settings, esketamine is administered via single bolus, continuous infusion or as an adjuvant in patient-controlled analgesia to reduce opioid requirements, improve pain scores and attenuate surgical stress responses. Beyond analgesia, low-dose protocols target early postoperative depression, anxiety and inflammatory sequelae, offering accelerated mobilisation and enhanced functional recovery. Clinicians worldwide are refining dosing strategies to balance efficacy with safety, optimising haemodynamic stability and minimising psychotomimetic effects. As part of multimodal analgesia regimens, esketamine is increasingly recognised for its capacity to improve both somatic and psychological outcomes, underlining its global significance in enhancing recovery after surgery.
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Esketamine Applications in Postoperative Management publication trend
The graph below shows the total number of articles in esketamine applications in postoperative management across all publications each year (not limited to Nature Index journals).
Technical terms
Esketamine: The S-enantiomer of ketamine with higher affinity for NMDA receptors, used for analgesia and rapid antidepressant effects.
NMDA receptor antagonist: A compound that inhibits N-methyl-D-aspartate receptors, disrupting excitatory neurotransmission to alleviate pain and modulate mood.
Patient-controlled intravenous analgesia (PCIA): A delivery system that allows patients to self-administer predetermined doses of analgesic agents through an intravenous pump.
Edinburgh Postnatal Depression Scale (EPDS): A validated screening questionnaire for detecting depressive symptoms in the postnatal period.
Subanesthetic dose: A dose below the threshold required to induce full anaesthesia, employed to provide analgesia or sedation with minimal loss of consciousness.
References
- Effects of perioperative use of esketamine on postpartum depression risk in patients undergoing cesarean section: A randomized controlled trial. Journal of Affective Disorders (2023).
- S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression: a randomized controlled trial. BMC Anesthesiology (2022).
- Effect of subanesthetic dose of esketamine on postoperative rehabilitation in elderly patients undergoing hip arthroplasty. Journal of Orthopaedic Surgery and Research (2023).
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