In brief
- A randomized, double-blind trial involving 134 patients undergoing gynecological laparoscopy.
- An opioid-free combination of esketamine and dexmedetomidine managed pain as effectively as sufentanil.
- Patients in the opioid-free group reported higher quality-of-recovery scores, particularly regarding physical comfort and mood.
A research team at a hospital affiliated with the First University Hospital of Beijing, based in Yinchuan (Ningxia), has tested whether it is possible to forgo opioids during post-operative recovery for gynecological laparoscopic surgery by substituting them with esketamine combined with dexmedetomidine. The results, published in Annals of Medicine, show that pain was controlled just as effectively as with standard opioids, while overall recovery was superior.
Study design
The trial, a 1:1 randomized, double-blind study, included 134 adult women undergoing scheduled gynecological laparoscopy, with 132 analyzed on an intention-to-treat basis. One group received patient-controlled intravenous analgesia with esketamine (1 mg/kg) plus dexmedetomidine (3 micrograms/kg), without opioids. The other received the standard regimen using sufentanil (2 micrograms/kg). The trial had been registered since December 2023 in the Chinese Clinical Trial Registry (ChiCTR2300078569).
The results
Regarding pain during coughing at 48 hours, measured as the area under the curve of the NRS scale, the opioid-free group remained within the non-inferiority margin compared to sufentanil (175 vs. 169; mean difference of 6, with a non-inferiority margin set at 24). On the QoR-15 quality-of-recovery scale, the esketamine and dexmedetomidine group achieved a significantly higher mean score (116 vs. 108; an 8-point difference), driven primarily by better physical comfort and improved emotional state, with pain scores comparable between both groups. The authors reported no serious adverse effects in either arm.
Implications
This is a relatively small trial involving a single type of surgery at one Chinese center, so its results cannot yet be extrapolated to other procedures or patient profiles. However, it adds to a growing body of research seeking to reduce post-operative opioid exposure by utilizing esketamine—already used in anesthesia—in doses and combinations distinct from those used in psychiatry for treatment-resistant depression. The study itself proposes this regimen as “a promising alternative strategy” for analgesia following this type of surgery, pending confirmation in further centers and populations.
For more on what is known about ketamine and other dissociatives, as well as the risks to be aware of, consult the Psiconáutica guide on ketamine and dissociatives. This trial joins others exploring the role of ketamine and its derivatives in perioperative pain, such as the large-scale trial evaluating ketamine after orthopedic trauma.
Source
- Ren Y, Li YT, Yin QL, et al. Opioid-free analgesia with esketamine-dexmedetomidine versus opioid-based analgesia after gynaecological laparoscopic surgery: a double-blind, randomized, controlled trial. Annals of Medicine, September 16, 2026. DOI: 10.1080/07853890.2026.2732292.
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
