The Comparison of the Efficacy of Esketamine Over Sufentanil to Reduce Postoperative Nausea and Vomiting in Gynecological Laparoscopic Surgery: A Prospective, Double-Blind, Randomized Controlled Trial.

Background: Postoperative nausea and vomiting (PONV) affect 40-80% of patients undergoing gynecological laparoscopy (GLS). Opioids, though effective for analgesia, may exacerbate PONV. Esketamine, the dextrorotatory form of ketamine with analgesic, sedation and anti-inflammatory properties, was evaluated for PONV prophylaxis compared to sufentanil. Methods: In this single-center, double-blind trial, 150 patients undergoing elective GLS were randomized to receive esketamine (0.25mg/kg, n=75) or sufentanil (0.1μg/kg, n=75) at the incision closing. Primary outcomes were PONV incidence and severity in Postanesthesia care unit (PACU) and during 48 hours postoperation. Secondary outcomes included pain scores, supplemental analgesia use, sore throat and bucking at excubation. Statistical analyses utilized t-tests, Mann-Whitney U, and χ²-tests (significance: p < 0.05) with Friedman test for within-group comparisons and generalized estimating equations (GEE) for group-time interaction evaluation. Results: The esketamine group demonstrated significantly lower PONV incidence (in PACU: 57.3% vs 36%, p=0.014; 24h: 53.3% vs 36%, p=0.048) and reduced severity within 24 hours (in PACU, p<0.001; 6h, P=0.042; 24h, p=0.029). Secondary outcomes favored esketamine: lower dynamic pain scores during coughing (in PACU, p=0.017; 6h, P=0.021; 24h, p=0.012), lower severity of sore throat (6h, P=0.019; 24h, p=0.028), reduced rescue analgesia needs (6h: RD=0.12, p=0.037), and decreased incidence of bucking reflex (RD=0.21, p=0.014). Conclusion: Single-dose esketamine significantly reduces PONV incidence and severity in GLS, improves dynamic analgesia, and mitigates extubation complications. These results support the single dose use of esketamine as an opioid-sparing adjunct to prevent PONV in gynecological laparoscopy.