{ "abstract": "Patients with morbid obesity are at a high risk of comorbid depressive and anxiety symptoms. While bariatric surgery is an effective treatment, conventional opioid-based anesthesia carries significant perioperative risks. Opioid-free anesthesia (OFA) presents a safer alternative. Esketamine, known for its dual analgesic and rapid antidepressant effects, is a promising component of OFA. However, clinical evidence supporting its simultaneous benefits for both physical and psychological recovery in bariatric patients remains limited. In this double-blind, randomized clinical trial, patients scheduled for laparoscopic sleeve gastrectomy were randomly assigned (1:1) to receive either esketamine-based anaesthesia or opioid-based anaesthesia with remifentanil during surgery. The co-primary outcomes were postoperative pain intensity within the first 24 h and mental health status at three months after surgery. Secondary outcomes included pharmacokinetics of esketamine and adverse events. A total of 84 patients were randomized, with 42 allocated to each group. Seventy-four participants (88.1%) completed the 3-month follow-up. Patients in the esketamine group experienced significantly lower postoperative pain intensity (P < 0.01) and a reduced incidence of moderate-to-severe pain (P < 0.05) within 24 h after surgery. Mental health outcomes at 3 months were also significantly better in the esketamine group, and adverse events rate did not differ significantly. Pharmacokinetic analysis showed that plasma esketamine concentrations increased rapidly during infusion, with early formation of the active metabolite (S)-norketamine. Compared to opioid-based anaesthesia, esketamine-based opioid-free anaesthesia was associated with improved postoperative analgesia and better mental health outcomes in morbidly obese patients undergoing bariatric surgery, without increasing adverse events.", "abstract_shown": true, "affiliations": [ "Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.", "Shandong Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.", "Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, China.", "Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.", "Department of Health Sciences and Technology, Anhui University, Hefei, China.", "Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.", "Second clinical college, Anhui Medical University, Hefei, China.", "Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.", "Department of Anaesthesiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China, Hong Kong, China.", "Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.", "Department of Anaesthesiology, Peking University First Hospital, Beijing, China.", "Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China. jbl1985@163.com.", "Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China. linlu@bjmu.edu.cn.", "National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China. linlu@bjmu.edu.cn.", "Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China. xueqi@ahmu.edu.cn." ], "article_type": "research article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0, 1 ], "name": "Chunxia Huang" }, { "affs": [ 2, 3 ], "name": "Zichun Guan" }, { "affs": [ 4 ], "name": "Sheng Wang" }, { "affs": [ 0 ], "name": "Wu Liu" }, { "affs": [ 5 ], "name": "Fuqiang Zu" }, { "affs": [ 6 ], "name": "Jinkai Sun" }, { "affs": [ 7 ], "name": "Feng Geng" }, { "affs": [ 0 ], "name": "Rui Li" }, { "affs": [ 8 ], "name": "Gordon Tin Chun Wong" }, { "affs": [ 0 ], "name": "Ye Zhang" }, { "affs": [ 9 ], "name": "Andreas Reif", "orcid": "0000-0002-0992-634X" }, { "affs": [ 10 ], "name": "Dongxin Wang" }, { "affs": [ 11 ], "name": "Benli Jia" }, { "affs": [ 12, 13 ], "name": "Lin Lu", "orcid": "0000-0003-0742-9072" }, { "affs": [ 14 ], "name": "Qi Xue", "orcid": "0000-0001-5644-1874" } ], "bibtex": "https://research.draconitic.com/paper/8hjhtb2hv448x.bib", "cited_by": 0, "doi": "10.1038/s41398-026-04241-w", "fulltext_url": "https://europepmc.org/articles/PMC13677711", "id": "8hjhtb2hv448x", "issns": [ "2158-3188" ], "landing_url": "https://europepmc.org/article/MED/42893989", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "RC321-571" ], [ "openalex", "2746|Anesthesia and Pain Management" ] ], "openalex": "W7170177924", "pdf_url": "https://europepmc.org/articles/PMC13677711?pdf=render", "pmcid": "PMC13677711", "pmid": "42893989", "published": "2026-07-01", "publisher": "Nature Publishing Group", "ris": "https://research.draconitic.com/paper/8hjhtb2hv448x.ris", "sources": [ { "first_seen": "2026-10-30T12:19:41Z", "native_id": "MED:42893989", "source": "europepmc", "url": "https://europepmc.org/article/MED/42893989" }, { "first_seen": "2026-10-30T13:46:27Z", "native_id": "d52480c1c20e4f8ca4fb5b596290856f", "source": "doaj", "url": "https://doi.org/10.1038/s41398-026-04241-w" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2746|Anesthesia and Pain Management", "subfield": "surgery" } ], "title": "Dual benefit of esketamine-based opioid-free anesthesia on postoperative pain and mental health outcomes in patients undergoing bariatric surgery: a randomized controlled trial.", "title_text": "Dual benefit of esketamine-based opioid-free anesthesia on postoperative pain and mental health outcomes in patients undergoing bariatric surgery: a randomized controlled trial.", "type": "peer-reviewed", "updated_at": "2026-10-30T13:46:27Z", "url": "https://research.draconitic.com/paper/8hjhtb2hv448x", "venue": "Translational psychiatry", "versions": [] }