Dual benefit of esketamine-based opioid-free anesthesia on postoperative pain and mental health outcomes in patients undergoing bariatric surgery: a randomized controlled trial
In brief
Esketamine anesthesia improved pain and 3-month mental health after bariatric surgery
In a randomized trial of 84 patients having sleeve gastrectomy, esketamine-based anesthesia reduced pain in the first 24 hours and improved mental health at three months compared with remifentanil-based anesthesia. Adverse-event rates did not differ, and 74 patients completed follow-up. The results are encouraging, but the small trial leaves the size and durability of the benefits uncertain.
- Journal
- Translational psychiatry (Q1)
- Published
- 23 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Chunxia Huang, Zichun Guan, Sheng Wang, Wu Liu, Fuqiang Zu, Jinkai Sun, et al.
- PMID
- 42893989
- DOI
- 10.1038/s41398-026-04241-w
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 20 October 2026): Esketamine opioid‑free anaesthesia improves pain and mental health
- Picked for Surgery (paper of the day, 20 October 2026): Esketamine OFA lowers pain and improves mental health
Abstract
Patients with morbid obesity are at a high risk of comorbid depressive and anxiety symptoms. While bariatric surgery is an effective treatment, conventional opioid-based anesthesia carries significant perioperative risks. Opioid-free anesthesia (OFA) presents a safer alternative. Esketamine, known for its dual analgesic and rapid antidepressant effects, is a promising component of OFA. However, clinical evidence supporting its simultaneous benefits for both physical and psychological recovery in bariatric patients remains limited. In this double-blind, randomized clinical trial, patients scheduled for laparoscopic sleeve gastrectomy were randomly assigned (1:1) to receive either esketamine-based anaesthesia or opioid-based anaesthesia with remifentanil during surgery. The co-primary outcomes were postoperative pain intensity within the first 24 h and mental health status at three months after surgery. Secondary outcomes included pharmacokinetics of esketamine and adverse events. A total of 84 patients were randomized, with 42 allocated to each group. Seventy-four participants (88.1%) completed the 3-month follow-up. Patients in the esketamine group experienced significantly lower postoperative pain intensity (P < 0.01) and a reduced incidence of moderate-to-severe pain (P < 0.05) within 24 h after surgery. Mental health outcomes at 3 months were also significantly better in the esketamine group, and adverse events rate did not differ significantly. Pharmacokinetic analysis showed that plasma esketamine concentrations increased rapidly during infusion, with early formation of the active metabolite (S)-norketamine. Compared to opioid-based anaesthesia, esketamine-based opioid-free anaesthesia was associated with improved postoperative analgesia and better mental health outcomes in morbidly obese patients undergoing bariatric surgery, without increasing adverse events.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.