Low-dose esketamine for postoperative pain, sleep, and hemodynamic stability in functional endoscopic sinus surgery: a retrospective cohort study.

OBJECTIVE: To evaluate the efficacy and safety of low-dose esketamine (0.2 mg/kg or 0.3 mg/kg) in improving postoperative pain, sleep quality, hemodynamic stability, and emotional status in functional endoscopic sinus surgery (FESS) patients. METHODS: This retrospective cohort study analysed 135 chronic rhinosinusitis patients (January 2021-December 2023) divided into control (normal saline, n = 45), 0.2 mg/kg esketamine (n = 45), and 0.3 mg/kg esketamine (n = 45) groups. Propensity score matching (PSM)-balanced baselines. Primary outcome: 24-hour post-operative VAS pain score. Secondary outcomes included sleep/emotion/hemodynamic indices and adverse events. Python-based statistical analyses were performed. RESULTS: After PSM, 40 patients/group were analysed. The 0.3 mg/kg (5.82 ± 1.89) and 0.2 mg/kg (6.53 ± 1.59) groups had significantly lower 24-hour VAS scores than the control group did (7.16 ± 0.93, P < 0.001), with the 0.3 mg/kg group being superior (P = 0.032). The eyesketamine group had better sleep quality (PSQI: 3.53 ± 0.69-6.31 ± 0.51 vs. 9.07 ± 1.12; P < 0.001), reduced anxiety/depression (HAM-A/HAM-D), improved resilience (CD-RISC), and less vasoactive drug use (P < 0.001). Adverse events were lower, with no increased neuropsychiatric reactions. CONCLUSION: The use of low-dose esketamine (particularly 0.3 mg/kg) in FESS patients is associated with clinically meaningful improvements in pain control, sleep quality, emotional well-being, and hemodynamic parameters, alongside a favorable safety profile with no increase in neuropsychiatric adverse events. These findings support its consideration as a viable non-opioid analgesic adjunct in this surgical setting.