The Effects of Intraoperative Esketamine on Postoperative Pain and Mood in Patients With Inflammatory Bowel Disease
Status:
Completed
Trial end date:
2022-03-01
Target enrollment:
Participant gender:
Summary
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract with
symptoms evolving in a relapsing and remitting manner. Typically, the peak incidence of CD is
18 to 35 years , which means that patients with CD will be plagued by the disease during
their most precious years, and nearly 35% of them will develop depressive symptoms. For 70%
of patients with CD who need surgery, the incidence of preoperative depression may be higher.
The CD cohort with diagnosable psychological condition has been shown to experience a higher
rate of disease exacerbation than the CD cohort without psycho complication. At the same
time, this depressive mood may make postoperative recovery more difficult, so it is necessary
to alleviate postoperative depression.
Ketamine, a widely used anesthetic, is also used to treat depression. The most used ketamine
in clinical practice is racemic ketamine, but its use is associated with many complications
such as psychotic adverse effects and neurotoxicity. In recent years, S-ketamine has received
attention for better efficacy and fewer complications . In 2019, the Food and Drug
Administration (FDA) approved S-ketamine nasal spray for the treatment of refractory
depression and subsequently received approval from numerous health authorities around the
world. This proves that S-ketamine can provide a rapid antidepressant effect in patients with
depression in a non-surgical setting. However, it is inconclusive whether S-ketamine affects
surgical patients, mainly because of differences in the type of surgery, the dosage
administered, the interaction with analgesics, and the evaluation tools implemented. Studies
have shown that small doses of S-ketamine in breast cancer surgery and cervical cancer
surgery can reduce postoperative depression. However, the effects of S-ketamine on
postoperative depression (POD) and pain in patients with CD have not been studied.