Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

Abstract

Purpose

Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.

Patients and Methods

This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events.

Results

The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups.

Conclusion

The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.

Keywords:

• S-ketamine
• postoperative nausea and vomiting
• hemodynamics
• non-opioid analgesic
• postoperative pain
• video-assisted thoracoscopic surgery lobectomy

Data Sharing Statement

All data generated or analyzed during this study were included in the published article. Further inquiries about the datasets can be directed to the corresponding author on reasonable request. Any information we share will be deidentified.

Disclosure

The authors declare no competing interests in this work.

Additional information

Funding

This study received support from the Key Research and Development Program of Scientific and Technological Innovation in Xuzhou City (No. KC21251), grant (Dr. Yu Qi), the Opening Project of Jiangsu Key Laboratory of Anesthesiology (No. XZSYSKF2021011), grant (Dr. Hai Zhou) and Jiangsu Provincial Key Medical Discipline/Laboratory Construction Unit Fund Project(No. JSDW202231), grant (Dr. Liwei Wang).