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Esketamine demonstrates superior analgesic efficacy and has the higher probability of being the optimal treatment for reducing early postoperative sleep disturbance incidence compared to dexmedetomidine.

In a network meta-analysis of 10 RCTs (645 patients), esketamine significantly reduced VAS pain scores at rest and during movement at 24 and 48 hours postoperatively. Both esketamine and dexmedetomidine reduced the incidence of PSD on the first postoperative day, but esketamine showed a stronger effect (RR=0.655 vs RR=0.773). Esketamine also improved subjective sleep outcomes (AIS, NRS) more effectively, likely due to its superior analgesia.

Last updated: Aug 8, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score49/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Comparative Efficacy of Dexmedetomidine and Esketamine on Postoperative Sleep Disturbances and Analgesia: A Systematic Review and Network Meta-Analysis.

observational

Jiang T, Zhao R, Zhang Y, Zhang R, Wu X, Jin L, Huang Y, Zhang Y, Czyzewski W, Staskiewicz G, Pruszynski K, Huang C, Zhu B · Pain physician (2026)

Participants: N/A
Duration: Not specified (studies from inception to August 2025)
Intervention: Perioperative administration of esketamine or dexmedetomidine compared to control (placebo or standard care).
Outcome: Postoperative pain scores (VAS at 24 and 48 hours), incidence of PSD, Athens Insomnia Scale (AIS) scores, sleep quality (NRS), and objective sleep architecture via polysomnography.
Effect Size: Esketamine RR=0.655 (95% CrI: 0.517-0.798) for PSD incidence; dexmedetomidine RR=0.773 (95% CrI: 0.434-1.23).
Population: Adult surgical patients from RCTs conducted in China.

Result:

PubMed: 42550519

Mechanism Graph

Surgery induces postoperative sleep disturbance and heightened pain sensitivity.
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Esketamine provides superior analgesia compared to dexmedetomidine.
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Better pain control reduces pain-related sleep disruption.
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Improved analgesia leads to reduced early PSD incidence and better subjective sleep quality.

Limitations

  • ⚠All included trials were conducted in China, limiting generalizability to other populations.
  • ⚠The number of included RCTs (10) and patients (645) is relatively small, and the PSG analysis included only 4 studies (n=182).

Frequently Asked Questions

Which drug is more effective for reducing postoperative pain?▼

Esketamine demonstrated significantly superior analgesic efficacy, reducing VAS pain scores at rest and during movement at 24 and 48 hours postoperatively compared to dexmedetomidine.

Does dexmedetomidine improve objective sleep architecture?▼

Yes, a supplementary meta-analysis of 4 PSG studies found that dexmedetomidine increased the percentage of stage N2 sleep (MD=13.0%) and showed a non-significant trend toward increasing stage N3 sleep (OR=2.99).

What is the primary outcome of this meta-analysis?▼

The primary outcomes were postoperative pain scores measured by VAS at 24 and 48 hours. Secondary outcomes included PSD incidence, AIS scores, and sleep quality on NRS.

Are these findings applicable to all surgical patients?▼

Caution is advised because all trials were conducted in China, and the sample size was relatively small. Further research in diverse populations is needed.

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References

  1. 1.Jiang T, Zhao R, Zhang Y, Zhang R, Wu X, Jin L, Huang Y, Zhang Y, Czyzewski W, Staskiewicz G, Pruszynski K, Huang C, Zhu B. "Comparative Efficacy of Dexmedetomidine and Esketamine on Postoperative Sleep Disturbances and Analgesia: A Systematic Review and Network Meta-Analysis.." Pain physician, 2026. PMID: 42550519
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.