Abstract

Postoperative recovery indicates the restoration of physiological stability, functional capacity, mood, and effective pain control following surgery. Traditional recovery measures tend to focus on negative events and the duration of hospitalization. In contrast, patient-reported research, such as Quality of Recovery (QoR) scales, offers a more holistic assessment of recovery after surgery. The antidepressant and pain-killing effects of sketamine (the antipsychotic form of ketamine) can be improved, and a neuroactive stimulant might be beneficial in the early postoperative recovery of cancer patients. The study was a systematic review and meta-analysis that assessed the efficacy of perioperative esketamine in patient-reported recovery after cancer surgery. Up to January 23, 2025, PubMed, Web of Science, Scopus, and Cochrane Library were searched to apply a PRISMA-compliant literature search. Randomized controlled trials (RCTs) that compared esketamine and placebo and reported postoperative QoR outcomes were included. A random-effects model was used to synthesize the data, and differences in means were pooled, and 95% confidence intervals (CI) were calculated, along with heterogeneity measurement using the i² statistic. Eight RCTs and 1,223 patients (614 on esketamine and 609 on placebo) were analyzed. Esketamine had a significant positive effect on postoperative QoR, which was much stronger than placebo (mean difference 4.11; 95% CI 1.776.45; p = 0.001), but a lot of heterogeneity was also present (i² = 86%), primarily to do with dosing regimens and the scale of QoR. Analysis of the subgroups indicated that there was a significant advantage with the implementation of QoR-15, but not QoR-40. Intraoperative administration of esketamine at 0.1 mg/kg/h continuously yielded a clinically significant effect of the drug, and no further improvement was achieved with increased dosage. The most significant response was found on the day 1 postoperative, and its effects decreased towards the further days. On the whole, perioperative esketamine improves early patient-reported recovery following cancer surgery and is worth further investigation to improve the dosing regimen and evaluate its long-term effectiveness.

Key words: Esketamine, Postoperative Recovery, Quality of Recovery (QoR), Cancer Surgery, Patient-Reported Outcomes, Randomized Controlled Trials, Systematic Review, Meta-Analysis, Analgesia, NMDA Receptor.