Intraoperative esketamine infusion reduces early postoperative sleep disturbance in patients undergoing shoulder arthroscopy
In a randomized controlled trial of 80 patients with preoperative sleep disturbance undergoing shoulder arthroscopy, intraoperative esketamine infusion (0.3 mg/kg/h) significantly reduced the incidence of sleep disturbance on postoperative day 1 compared to placebo (5.0% vs. 27.5%; risk ratio 0.18, 95% CI 0.04-0.77). The esketamine group also showed longer device-estimated total sleep time on POD1 and lower Athens Insomnia Scale scores on POD1, POD3, and POD7, with improved PSQI scores at POD30.
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Intraoperative esketamine infusion reduces early postoperative sleep disturbance in patients undergoing shoulder arthroscopy The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Intraoperative esketamine infusion reduces early postoperative sleep disturbance in patients undergoing shoulder arthroscopy
This conclusion is most relevant to: Adult patients with preoperative sleep disturbance undergoing shoulder arthroscopy.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Intraoperative esketamine infusion and postoperative sleep quality after shoulder arthroscopy: a randomized controlled trial. (Frontiers in pharmacology, 2026) —
How It Works
The proposed biological pathway:
- ▸Esketamine blocks NMDA receptors, reducing central sensitization
- ▸Decreased pain perception during and after surgery
- ▸Improved pain control reduces sleep disruption
- ▸Result: Lower incidence of postoperative sleep disturbance
Who Might Benefit
Evidence fit by population:
- ▸Adult patients with preoperative sleep disturbance undergoing shoulder arthroscopy
Recommended Dose
0.3 mg/kg/h intraoperative infusion
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Single-center design limits generalizability
- ▸Small sample size (n=80) may affect precision of estimates
- ▸Wearable-derived sleep parameters are exploratory and not validated against polysomnography
Frequently Asked Questions
What is the primary outcome measured in this study?▼
The primary outcome was sleep disturbance, defined as an Athens Insomnia Scale score ≥6 on postoperative day 1.
How much esketamine was given to patients?▼
Patients received an intraoperative infusion of esketamine at a dose of 0.3 mg/kg/h.
Did esketamine improve sleep quality beyond the first postoperative day?▼
Yes, subjective sleep measures favored the esketamine group, with lower Athens Insomnia Scale scores on POD1, POD3, and POD7, and lower PSQI scores at POD30.
What are the main limitations of this trial?▼
The trial was single-center with a small sample size, and the wearable sleep monitoring used exploratory parameters not validated against gold-standard polysomnography.
References
- 1.Liu C, Lu W, Ni L, Yao S. “Intraoperative esketamine infusion and postoperative sleep quality after shoulder arthroscopy: a randomized controlled trial..” Frontiers in pharmacology, 2026. PMID: 42460017 DOI: 10.3389/fphar.2026.1864069