The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial.

Nasal administration of esketamine effectively relieves acute pain after CT-guided needle localization before lung surgery. In a double-blind, placebo-controlled trial, 90 patients with pain scores above 3 on a 10-point scale received either a low or high dose of esketamine or saline. Satisfactory pain relief—a score of 3 or lower 15 minutes after treatment—occurred in 56.7% of patients given 0.3 mg/kg esketamine, 53.3% given 0.5 mg/kg, but only 16.7% given saline. Those receiving esketamine also required less rescue pain medication and had similar rates of side effects. The results indicate that intranasal esketamine is a safe and effective option for managing acute pain in this setting.

Study at a glance

Abstract

Whether nasal administration of esketamine can provide effective analgesia is unclear in patients with acute pain after preoperative CT-guided needle localization. In this double-blind, randomized, placebo-controlled trial, patients were assigned to receive either nasal administration of esketamine (0.3 mg/kg or 0.5 mg/kg) or saline (identical in appearance to esketamine) when they had visual analog scale (VAS) pain scores >3/10 during deep breathing after preoperative CT-guided needle localization. The primary outcome was the percentage of patients with satisfactory pain relief, which was defined as VAS pain scores ≤3/10 measured 15 min after intranasal of esketamine or saline. Secondary outcomes included VAS measured following esketamine or saline, the incidence and cumulative dose of rescue hydromorphone use, and related adverse events. A total of 90 patients were included in the final analysis. Following intranasal treatment, the percentage of patients with satisfactory pain relief was 16.7% (5/30) in the saline group, 56.7% (17/30) in the 0.3 mg/kg esketamine group, and 53.3% (16/30) in the 0.5 mg/kg esketamine group (p = 0.002). The median VAS during deep breathing was less after the intranasal administration of esketamine {median (IQR), 3 (3, 5) in 0.3 mg/kg or 0.5 mg/kg esketamine compared to the saline group [5 (4, 6)], p = 0.009}. The incidence of rescue hydromorphone use was detected less in the esketamine group compared to the saline group (43.3% in the 0.3 mg/kg esketamine group, 36.7% in the 0.5 mg/kg esketamine group, and 73.3% in the saline group, p = 0.010). The adverse events were similar among the three groups (p > 0.05). Intranasal administration of esketamine is easier and more effective in alleviating acute pain in patients after preoperative CT-guided needle localization without significant adverse effects.