Esketamine emerges as a promising option for ureteroscopy pain

Discomfort related to the catheter following ureteroscopy could be greatly reduced by administering esketamine. This analgesic, twice as potent as ketamine, would also cause fewer side-effects for patients.This is demonstrated by a randomized, double-blind trial involving 168 patients aged 18 to 65 years who underwent ureteroscopy with lithotripsy under general anesthesia. Patients who received an injection of esketamine during the procedure were three times less likely to experience moderate to severe pain after ureteral catheter placement. These results were published in BMC Anesthesiology.Three groupsParticipants were divided into three groups based on the treatment they received 30 minutes before the end of the procedure: esketamine 0.15 mg/kg (n=55), esketamine 0.25 mg/kg (n=55), and 2 mL of saline solution (placebo group, n=56).At zero hours postoperatively, the proportion of patients experiencing moderate to severe discomfort was significantly lower in the group receiving esketamine at 0.25 mg/kg compared to the placebo group (9.1% vs. 33.9%). This effect persisted until the end of the observation period, i.e., six hours postoperatively. At this time, 3.6% of patients receiving the higher dose of esketamine experienced moderate to severe symptoms, while the proportion reached 19.6% in patients receiving saline.Patients could receive tramadol as rescue analgesia. Few patients receiving esketamine requested tramadol (9.09%), while 41% of patients in the placebo group required it to relieve their discomfort. The required doses of tramadol were also lower in patients receiving esketamine during their surgery.At a reduced dose (0.15 mg/kg), esketamine did improve patient comfort, but to a lesser extent. The concentration of 0.25 mg/kg therefore appears to be the most effective for relieving moderate to severe pain following ureteroscopy.It is estimated that 38% to 60% of patients will experience moderate to severe pain attributable to the ureteral stent.“Catheter-related bladder discomfort not only induces anxiety, pain and increased requirements for analgesia in patients, but also elevates the incidence of complications, including surgical site bleeding, incision rupture, and arrhythmias, thereby prolonging hospital stays,” the study authors noted.More powerful than ketamineKetamine is already recognized as an effective analgesic for relieving bladder pain. However, it causes undesirable psychomimetic effects, such as hallucinations and dysphoria, which limits its clinical utility.Esketamine, on the other hand, is just as effective as ketamine at blocking muscarinic receptors, which are responsible for involuntary bladder contractions. Its analgesic potential is twice as high, and its half-life is shorter, accelerating its elimination.At equivalent doses, esketamine is also associated with fewer psychiatric sideeffects, fewer effects on memory and concentration, and faster postoperative recovery.

Esketamine emerges as a promising option for ureteroscopy pain

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