Objective: In patients undergoing laparoscopic hysterectomy, this study compared two anesthetic approaches-esketamine-based opioid-free anesthesia and opioid-based anesthesia-to assess their impact on postoperative recovery quality.
Patients and methods: This prospective trial randomly assigned 91 patients undergoing laparoscopic hysterectomy to receive either esketamine-based anesthesia (induction and maintenance with esketamine, without perioperative opioids) or conventional opioid-based anesthesia. The primary endpoint was defined as the Quality of Recovery-40(QoR-40) score measured on postoperative day (POD) 1. Secondary measures comprised the QoR-40 score on POD 3, pain scores after surgery, hemodynamic variables, and adverse events.
Results: On POD1, compared to the opioid group, the esketamine group exhibited a significantly elevated QoR-40 score (p < 0.001), but scores were similar by POD3 (p = 0.333). The esketamine group experienced a lower rate of postoperative nausea and vomiting (PONV) (17.8% vs. 37.0%, p = 0.040), whereas the two groups had comparable pain scores at every time point measured (all p > 0.05).
Conclusion: Among laparoscopic hysterectomy patients, esketamine-based opioid-free anesthesia was linked to higher POD1 QoR-40 scores and fewer PONV events than opioid-based anesthesia. However, given the modest sample size, these preliminary findings warrant confirmation in larger multicenter trials.
Trial registration: We prospectively registered the study protocol in the Chinese Clinical Trial Registry. (ChiCTR2300075661) on September 12, 2023.
Keywords: Esketamine; Laparoscopic hysterectomy; Opioid-free anesthesia; Recovery quality.
© 2026. The Author(s).