Preoperative Anxiety's Impact on the Median Effective Dose of Esketamine for Alleviating Propofol Injection Pain in Patients Undergoing Painless abortion: A Randomized, Double-Blind, Controlled Trial.

A higher dose of esketamine reduces propofol injection pain, but patients who are anxious before surgery need a larger dose than those who are not. In a trial of 150 women undergoing painless abortion, those with preoperative anxiety (STAI-S score ≥40) required an effective dose for 50% of patients (ED50) of 0.133 mg/kg, compared to 0.114 mg/kg for non-anxious women—a statistically significant difference. No differences in side effects or blood pressure stability were seen between groups. Tailoring esketamine dose to a patient's anxiety level may improve pain management during anesthesia.

Study at a glance

Abstract

Propofol injection pain (PIP) is a frequent adverse effect during anesthesia induction, impacting patient comfort and satisfaction. Esketamine has been shown to alleviate PIP, but the optimal dose, especially in relation to preoperative anxiety levels, remains unclear. Preoperative anxiety may heighten pain perception and influence analgesic requirements. A randomized, double-blind, controlled trial was conducted at The Affiliated Women and Children's Hospital of Ningbo University. A total of 150 eligible patients scheduled for painless abortion were assessed using the Spielberger State Anxiety Inventory - State form (STAI-S) and categorized into non-anxious (STAI-S score <40) and anxious (STAI-S score ≥40) groups. Patients were randomized using a computer-generated random number table to receive one of five escalating doses of esketamine (0.10, 0.12, 0.14, 0.17, or 0.20 mg/kg) prior to propofol administration. The primary outcome was the occurrence of PIP, assessed using Ambesh's four-point pain scale. Secondary outcomes included hemodynamic parameters and adverse events such as hypotension, bradycardia, and hypoxemia. A clear dose-response relationship was observed, with higher doses of esketamine significantly reducing the incidence of PIP in both groups. Anxious patients required higher doses of esketamine to achieve comparable pain relief to non-anxious patients. The effective dose for 50% of patients (ED50) in the non-anxious group was 0.114 mg/kg (95% CI: 0.096-0.129 mg/kg), whereas it was 0.133 mg/kg (95% CI: 0.117-0.146 mg/kg) in the anxious group, with the difference being statistically significant (P < 0.05). No significant differences were observed between groups in terms of adverse events or hemodynamic stability. Preoperative anxiety significantly increases the ED50 of esketamine required to alleviate propofol injection pain in patients undergoing painless abortion. Anxious patients require higher doses of esketamine to achieve effective analgesia. Individualizing esketamine dosing based on preoperative anxiety levels may enhance patient comfort and optimize pain management during anesthesia.