Effect of esketamine on postoperative fatigue syndrome in elderly patients undergoing posterior lumbar fusion

doi:10.12092/j.issn.1009-2501.2026.01.007

Abstract

Abstract:

AIM: To investigate the effects of esketamine on postoperative fatigue syndrome (POFS), recovery quality and cellular immunity in elderly patients undergoing posterior lumbar fusion. METHODS: A total of 128 elderly patients scheduled for posterior lumbar fusion were randomly divided into esketamine group (Esk group, n=64) and normal saline group (NS group, n=64). Both groups underwent MTLIP block under ultrasound guidance before surgery. In the Esk group, 0.25 mg/kg esketamine was injected intravenously during anesthesia induction, followed by continuous infusion at 0.125 mg·kg^?1·h^?1 until 10 min before the end of surgery. In the NS group, equal-volume normal saline was injected in the same way. The concise perioperative Fatigue Rating Scale (ICFS-10) and Quality of Recovery Scale (QoR-15) were scored 1 day before surgery (D0), 1 day after surgery (D1), 3 days after surgery (D3), 7 days after surgery (D7) and 30 days after surgery (D30), respectively, and the incidence of POFS was analyzed. Peripheral venous blood samples were collected before anesthesia induction (T0), immediately after surgery (T1), 12 hours after surgery (T2), 24 hours after surgery (T3), 48 hours after surgery (T4) and 72 hours after surgery (T5), and the serum levels of IL-6, IL-10, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were detected. The intraoperative anesthetic drug consumption, extubation time, PACU stay time, postoperative hospital stay, postoperative nausea/vomiting and pain were recorded. RESULTS: Compared with the NS group, the incidence of POFS in the Esk group was significantly decreased on day 1 after surgery (53.3% vs. 32.8%, P=0.022), the ICFS-10 scores of the Esk group were significantly decreased at 1, 3 and 7 days after surgery (P<0.05), the QoR-15 score was significantly increased (P<0.01). The levels of IL-6 and CD8⁺ were significantly decreased at T1-T2 (P<0.05). The level of IL-10 was significantly increased at T1-T3 (P<0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ increased significantly at T1-T4 (P<0.05). The consumption of sufentanil, remifentanil and propofol during operation and the end-tidal concentration of sevoflurane were significantly reduced. The incidence of nausea/vomiting was significantly decreased 48 hours after surgery (P<0.05). The duration of postoperative ventilator assistance, PACU stay and postoperative hospitalization were significantly shortened. CONCLUSION: Esketamine can reduce the incidence of POFS and improve the quality of recovery in elderly patients with posterior lumbar fusion, and its mechanism may be related to inhibiting inflammatory response and improving cellular immune function.

Key words: esketamine, lumbar fusion, elderly patients, postoperative fatigue syndrome

CLC Number:

R614

Congli ZHANG, Yan YAN, Nannan SONG, Di LIU, Yang ZHANG, Pinghui ZHOU, Li REN, Fangtian FAN. Effect of esketamine on postoperative fatigue syndrome in elderly patients undergoing posterior lumbar fusion[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(1): 63-71.

Figures/Tables 4

References 30

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Item	Esk group (n=61)	NS group (n=60)	P-value
Age, median (IQR, y)	71(69-74)	72(69-75)	0.099
Female	33(54.1)	31(51.7)	0.789
BMI, median (IQR, kg/m²)	23.5(21.35-25.85)	22.85(21.25-24.45)	0.148
ASA grade (II/III)	21(34.4)/40(65.6)	26(43.3)/34(56.7)	0.315
Hypertension	36(59.0)	30(50)	0.319
Diabetes	10(16.4)	13(21.7)	0.460
Coronary atherosclerotic heart disease	6(9.8)	5(8.3)	0.774

Item	Esk group (n=61)	NS group (n=60)	P-value
Age, median (IQR, y)	71(69-74)	72(69-75)	0.099
Female	33(54.1)	31(51.7)	0.789
BMI, median (IQR, kg/m²)	23.5(21.35-25.85)	22.85(21.25-24.45)	0.148
ASA grade (II/III)	21(34.4)/40(65.6)	26(43.3)/34(56.7)	0.315
Hypertension	36(59.0)	30(50)	0.319
Diabetes	10(16.4)	13(21.7)	0.460
Coronary atherosclerotic heart disease	6(9.8)	5(8.3)	0.774

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Anaesthetics and analgesics, median (IQR)
Sufentanil (μg)	40(35-40)	50(45-50)	10(5-10)	<0.001
Remifentanil (mg)	0.6(0.5-0.8)	0.9(0.6-1.0)	0.20(0.10-0.30)	<0.001
Propofol (mg)	120(90-140)	135(105-159)	15(0-30)	0.011
End-expiratory concentration of sevoflurane (%)
Skin incision	0.93(0.74-1.17)	0.90(0.75-1.38)	0.05(?0.07-0.16)	0.265
30 min of operation	0.65(0.53-0.74)	0.87(0.73-0.97)	0.22(0.15-0.27)	<0.001
60 min of operation	0.50(0.42-0.61)	0.87(0.71-0.95)	0.31(0.25-0.37)	<0.001
Length of surgery (min, median)	126(101-143.5)	130(102.5-148.75)	4(?11-14)	0.709
Duration of postoperative ventilator assistance (min)	28(26-36)	35.5(28-40)	4(1-7)	0.008
Length of PACU stay (min)	53(46.5-58.5)	64(57-67)	9(7-12)	<0.001
Length of postoperative hospital stay (d)	6(5-7)	7 (6-8)	1(0-1)	0.010

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Anaesthetics and analgesics, median (IQR)
Sufentanil (μg)	40(35-40)	50(45-50)	10(5-10)	<0.001
Remifentanil (mg)	0.6(0.5-0.8)	0.9(0.6-1.0)	0.20(0.10-0.30)	<0.001
Propofol (mg)	120(90-140)	135(105-159)	15(0-30)	0.011
End-expiratory concentration of sevoflurane (%)
Skin incision	0.93(0.74-1.17)	0.90(0.75-1.38)	0.05(?0.07-0.16)	0.265
30 min of operation	0.65(0.53-0.74)	0.87(0.73-0.97)	0.22(0.15-0.27)	<0.001
60 min of operation	0.50(0.42-0.61)	0.87(0.71-0.95)	0.31(0.25-0.37)	<0.001
Length of surgery (min, median)	126(101-143.5)	130(102.5-148.75)	4(?11-14)	0.709
Duration of postoperative ventilator assistance (min)	28(26-36)	35.5(28-40)	4(1-7)	0.008
Length of PACU stay (min)	53(46.5-58.5)	64(57-67)	9(7-12)	<0.001
Length of postoperative hospital stay (d)	6(5-7)	7 (6-8)	1(0-1)	0.010

Item	Esk group (n=61)	NS group (n=60)	OR or MD (95% CI)	P -value
Primary outcome
Incidence of POFS
1 d after surgery	20(32.8)	32(53.3)	0.43(0.20-0.89)	0.022
3 d after surgery	19(31.1)	26(43.3)	0.59(0.28-1.25)	0.166
7 d after surgery	12(19.7)	18(30.0)	0.57(0.25-1.32)	0.188
30 d after surgery	2(3.3)	3(5.0)	0.64(0.10-4.00)	0.634
Secondary outcomes
ICFS-10 score, median (IQR)
1 d before surgery	17(15-18)	16(15-18)	0(?1-1)	0.577
1 d after surgery	22(20-28)	27(21-37)	3(1-7)	0.001
3 d after surgery	22(18.5-29)	23(21-35)	2(0-5)	0.013
7 d after surgery	21(18.5-24)	23(21-28)	2(0-4)	0.014
30 d after surgery	17(15-20)	17(16-19)	0(?1-1)	0.550
QoR-15 score, median (IQR)
1 d before surgery	128(125-131)	128(125-130)	?1(?2-1)	0.402
1 d after surgery	85(83-87)	80.5(78.3-85)	?4(?5-?3)	<0.001
3 d after surgery	96(91-100.5)	90(88-94.8)	?5(?7-?3)	<0.001
7 d after surgery	117(114-119)	110.5(108-113)	?6(?8-?5)	<0.001
30 d after surgery	126(120-132)	126(120-131)	?1(?3-1)	0.488
Postoperative adverse reactions
Nausea/Vomiting (0-48 h)	7(11.5)	17(28.3)	0.33(0.13-0.86)	0.020
Pain scores at 24 h (NRS), median (IQR)	2(0-2)	2(0-2.8)	0(0-0)	0.761
Pain scores at 48 h (NRS), median (IQR)	0(0-1)	0(0-1)	0(0-0)	0.672