The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial
Authors' conclusion
Adding esketamine and clonidine, as an individualised multimodal anaesthesia strategy, did not influence acute or persistent postoperative pain, early recovery, need of rescue opioids or PONV in patients, who were assessed as high risk for APOP.
Study context
- Population
- Adults, ASA I - II, elective laparoscopic surgery, high risk of pain based on perceived pain with venous cannulation
- Participants
- 125 adults
- Comparison
- Esketamine + clonidine vs standard of care
- Primary endpoint
- Worst pain intensity in the PACU
Methodological detailspatient- and assessor-blinded, superiority, single-centre, Single centre, 2022–2024
- Patient- and assessor-blinded
- Superiority
- Single-centre
- Single centre, 2022–2024
Primary result
As reported in the abstract
Worst pain score in the PACU
EC
5.7
Standard of care (SOC)
5.5
P = 0.78
Secondary outcomes
| Outcome | P value |
|---|---|
| Postoperative recovery · 24 hNo difference | P = 0.92 |
| PONV · 24 hNo difference | P = 0.80 |
| Persistent pain at rest · 3 and 6 monthsEC vs SOC · 3 months | P = 0.72 |
| Persistent pain at rest · 3 and 6 monthsEC vs SOC · 6 months | P = 0.12 |
| Persistent pain during movement · 3 and 6 monthsEC vs SOC · 3 months | P = 0.48 |
| Persistent pain during movement · 3 and 6 monthsEC vs SOC · 6 months | P = 0.18 |
- Worst pain at rest (NRS) · 24 h — Worst pain at rest, EC vs SOC · no difference
- 5.8 vs 6.1 · P = 0.35
- Worst pain during movement (NRS) · 24 h — Worst pain during movement, EC vs SOC · no difference
- 6.1 vs 6.2 · P = 0.68
- Proportion with NRS ≥ 4 in the PACU — Proportion with NRS ≥ 4 in the PACU, EC vs SOC
- 50 % vs 48 % · P = 0.55
- Proportion with NRS ≥ 4 at rest · 24 h — Proportion with NRS ≥ 4 at rest, EC vs SOC
- 73 % vs 81 % · P = 0.27
- Proportion with NRS ≥ 4 during movement · 24 h — Proportion with NRS ≥ 4 during movement, EC vs SOC
- 76 % vs 81 % · P = 0.50
- Rescue opioids in the PACU (exploratory) — Rescue opioids in the PACU, EC vs SOC · similar · exploratory outcome
- 5.9 mg vs 6.6 mg · P = 0.47
Persistent pain at rest · 3 and 6 months
- No differences in persistent pain at 3 or 6 months at rest
Persistent pain during movement · 3 and 6 months
- No differences in persistent pain at 3 or 6 months during movement
Original publication
The additive effect of esketamine and clonidine in patients at high risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial. J Clin Anesth. Published 4 November 2025. doi:10.
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