Mini-dose esketamine–dexmedetomidine combination to supplement analgesia for patients after scoliosis correction surgery: a double-blind randomised trial

Abstract

BackgroundPatients often experience severe pain after scoliosis correction surgery. Esketamine and dexmedetomidine each improves analgesia but can produce side-effects. We therefore tested the hypothesis that a mini-dose esketamine-dexmedetomidine combination safely improves analgesia. MethodsTwo hundred male and female adults having scoliosis correction surgery were randomised to patient-controlled sufentanil analgesia (4 μg kg−1 in normal saline) with either a combined supplement (esketamine 0.25 mg ml−1 and dexmedetomidine 1 μg ml−1) or placebo. The primary outcome was the incidence of moderate-to-severe pain within 72 h, defined as a numeric rating scale (NRS: 0=no pain and 10=worst pain) score ≥4 at any of seven time points. Amongst secondary outcomes, subjective sleep quality was assessed with an NRS score (0=best sleep and 10=worst sleep) for the first five postoperative nights. ResultsThere were 199 subjects included in the intention-to-treat analysis. Mean infusion rates were 5.5 μg kg−1 h−1 for esketamine and 0.02 μg kg−1 h−1 for dexmedetomidine. The primary outcome incidence was lower with the combined supplement (65.7% [65/99]) than with placebo (86.0% [86/100]; relative risk 0.76; 95% confidence interval: 0.65–0.90; P=0.001). Subjects given the combined supplement had lower pain intensity at rest at five time points (median difference –1 point; P≤0.005), lower pain intensity with movement at six time points (median difference –1 point; P≤0.001), and better subjective sleep quality for the first 5 postoperative nights (median difference –2 to –1 points; P<0.001). Adverse events did not differ between groups. ConclusionsThe mini-dose esketamine–dexmedetomidine combination safely improved analgesia and subjective sleep quality after scoliosis correction surgery. Clinical trial registrationNCT04791059.