Esketamine's Role in Enhancing Postoperative Sleep Quality

Esketamine and Postoperative Sleep Quality

A recent systematic review and meta-analysis, published on May 1, 2026, in an unknown TIER1 venue, suggests that esketamine significantly enhances subjective sleep quality in postoperative patients. This finding is based on a comprehensive analysis of randomized controlled trials (RCTs) that compared esketamine with placebo, standard care, or other sedatives. The primary outcome measured was postoperative subjective sleep quality, with secondary outcomes including sleep disturbance incidence, pain scores, anxiety, depression, and overall quality of recovery.

Mechanisms and Context

Esketamine, known for its analgesic and antidepressant properties, appears to have a beneficial impact on sleep quality when administered perioperatively. The review included 21 RCTs, with 15 studies specifically reporting on sleep quality among 6880 participants. Results demonstrated that esketamine improved sleep quality significantly on postoperative day one, with a standardized mean difference (SMD) of -0.40. Subgroup analyses revealed that higher doses and intraoperative administration were particularly effective. This suggests esketamine's potential to enhance recovery by improving sleep, thereby addressing a common postoperative complication.

Implications for Clinical Practice

The findings from this review could influence clinical practices and guidelines for postoperative care. By improving sleep quality, esketamine may expedite recovery and reduce the incidence of sleep-related complications. This positions esketamine as a multifaceted therapeutic agent, potentially expanding its use beyond its current indications. Healthcare providers may consider integrating esketamine into perioperative care protocols, especially for patients at high risk of sleep disturbances.

Risks and Unknowns

Despite the promising results, several risks and unknowns remain. The review did not find significant effects of esketamine on anxiety or depression outcomes, which warrants further investigation. Additionally, the long-term effects of perioperative esketamine use on sleep and recovery are not well understood. Potential side effects, particularly at higher doses, need careful consideration and monitoring in clinical settings.

Future Directions

Further research is necessary to explore the optimal dosing and timing of esketamine administration to maximize its benefits on postoperative sleep quality. Longitudinal studies could provide more insights into the sustained impacts of esketamine on recovery outcomes. As the evidence base grows, esketamine may become a staple in enhancing postoperative care, potentially leading to revised clinical guidelines and broader acceptance in surgical settings.