Improvement and clinical benefit analysis of low-dose ketamine on postoperative pain and sleep after sinus surgery

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Methods One hundred and thirty-five patients admitted to our hospital between June 2018 and September 2023 who suffered from sinusitis and were scheduled to undergo functional endoscopic sinus surgery were recruited. Three groups were divided as 0.2 mg (n = 45), 0.3 mg (n = 45), and control (n = 45) using a random number table. Three groups were tested for the Pittsburgh Sleep Quality Index (PSQI), the Visual Analogue Scale (VAS), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the Connor-Davidson Resilience Scale (CD-RISC), and the Sino-nasal Outcome Test-20 (SNOT-20), and the related scores were analyzed by comparing their means between the groups. Results Esketamine affected differently the PSQI, the VAS, the HAMD, the HAMA, the CD-RISC, and the SNOT-20 scores in patients ( F PSQI score treatment =67.569 F HAMD score treatment =59.593, F HAMA score treatment =71.479, F CD−RISC score treatment =65.549, F SNOT−20 score treatment =66.429, F VAS score treatment =56.73, all P 0.2 mg > 0.3 mg), while the order of the CD-RISC scores at the four-time points was: control < 0.2 mg < 0.3 mg. Conclusion Low-dose esketamine boasts relief of postoperative anxiety, pain, and depression, reduction of patient symptoms, and improvement of sleep quality after sinus surgery. esketamine sinus surgery sleep quality pain Figures Figure 1 Introduction The increased incidence of sinusitis has been witnessed in recent years as results of the contaminated environment and the increased social pressure. Chronic sinusitis (CRS), with a prevalence of 5–15%, has become one of the most common and frequently occurring diseases in otolaryngology [ 1 ] . It has been considered a serious public health problem due to severe interference with patients’ work and lives and lowering their survival quality [ 2 – 3 ] . Drug therapy alone is ineffective in CRS because of a high recurrence rate. Conventionally, nasal endoscopic surgery has been used for CRS treatment, with accompanying extensive invasive surfaces and multiple postoperative complications. As a result, this procedure in the clinic has gradually been eliminated. Functional endoscopic sinus surgery (FESS) thoroughly removes diseased tissues and restores normal morphology and physiological function of nasal and sinus mucosa [ 4 ] . FESS, characterized by small trauma, a clear operative field, and a broad surgical perspective, has been regarded as a preferred surgical technique for the treatment of CRS [ 5 ] . Although FESS causes tremendous pain in breathing, swallowing, and other postoperative maneuvers due to the anatomical structure of the surgical site and the peculiarities of physiological functions, such as postoperative head and face pain, especially in those with nasal packing and mainly manifests as nasal distension, and most in the whole head which seriously affects their sleep and diet [ 6 ] . In fact, all patients experienced varying degrees of pain after FESS [ 7 ] that even those with routine postoperative analgesia still had degrees of pain (VAS ≥ 5–6) at different periods after surgery (especially at 6h and 24h postoperatively), which proves that the effectiveness and safety of postoperative analgesia for FESS patients are of paramount importance. Opioids undoubtedly work better for analgesia but traditionally triggered adverse reactions such as skin itching, dizziness, nausea, and vomiting [ 8 ] ; therefore, it has become a common challenge for otolaryngologists and anesthesiologists to find an effective method of postoperative analgesia. Esketamine, also known as dextroketamine currently used as a common anesthetic drug, is the only intravenous anesthetic with mild respiratory effects that provides sedation, analgesia, and anesthesia. Recent studies [ 9 – 11 ] have demonstrated that subanesthetic doses of dexketamine cause favorable analgesia while reducing intraoperative or postoperative propofol and opioid dosage, contributing to smoother intraoperative hemodynamics, in which those, prophylactically infused 0.5 mg/kg of dexketamine at 2 µg/kg/min continuously for 12 h after cesarean section, were proved to be safe and some antinociceptive sensitization effects [ 10 ] ; those with continuous intravenous pumping of dextroketamine at 0.3 mg/kg/h during laparoscopic cholecystectomy was beneficial in decreasing morphine usage [ 11 ] . Additionally, esketamine can improve the objective sleep percentage of postoperative slow wave sleep (SWS) in patients undergoing gynecologic open surgery [ 12 ] , it can also safely apply for postoperative analgesia to alleviate pain and discomfort to a certain extent improvement of sleep quality. However, postoperative analgesia and improvement of sleep after the application of esketamine in patients with FESS are still in the exploratory stage, in which a small size sample for the relationship between dose and efficacy is common to limit our acknowledgement. Here, we based on the entry point of esketamine patients’ postoperative pain to reduce the usage of opioids and patients’ adverse reactions and explored its effect on the improvement of pain, sleep, and quality of life in patients with FESS. Study subjects and methods Study subjects One hundred and thirty-five patients who suffered from sinusitis and underwent functional endoscopic sinus surgery in the Guangzhou Twelfth People's Hospital between June 2018 and September 2023 were recruited and were randomly and equally divided into three groups using the random number table method [ 13 ] : 0.2 mg (n = 45), 0.3 mg (n = 45), and control (n = 45). The inclusion criteria were as follows: (1) patients with complete medical records; (2) those without severe cardiovascular, respiratory, hepatic or renal diseases; (3) those with a preoperative American Society of Anesthesiologists (ASA) classification of I to III; (4) those who were 18–70 years old; (5) those without hormones and immunosuppressant used before surgery; (6) those whose operation time was 8–17 o’clock; (7) those without a history of pepticulcer disease; (8) those without a history of addiction to analgesic drugs; (9) those without a history of migraine disease; (10) those who could cooperate with physical examination and pain assessment. The exclusion criteria were as follows: (1) those with an operative time of 180 min; (2) those with an operative bleeding volume of 20–200 ml; (3) those with intraoperative and postoperative allergic reactions; (4) those without cooperating with postoperative treatment and follow-up visits; (5) those with the developed severe infections after surgery; and (6) psychiatric patients. This study was approved by the Ethics Committee of our hospital under the ethical number 2024019. All the study subjects signed an informed consent form. Study methods Prior to induction, control, 0.2 mg/kg, and 0.3 mg/kg esketamine were injected intravenously into 3 ml of saline, 0.2 mg/kg esketamine (prepared in saline to 3 ml), and 0.3 mg/kg esketamine (prepared in saline to 3 ml), respectively. The specific anesthesia methods are shown below: all enrolled patients were administered general anesthesia by the same group of anesthesiologists. The volume of 3 ml esketamine (National Medical Products Administration No. H20193336) and an equal amount of saline were prepared by the nurse anesthetist before anesthesia, and then sterile syringes containing 3 ml of prepared esketamine or saline were distributed to the anesthesiologists. Anesthesia induction: anesthesia was performed by injecting remimazolam tosylate (National Medical Products Administration No. H20190034) 0.1mg/kg propofol medium/long-chain fat emulsion injection (National Medical Products Administration No. H20203571) 1–2 mg/kg, sufentanil ( National Medical Products Administration No. H20054171 ) 0.5 µg/kg, and cis-atracurium (National Medical Products Administration No. H20183042) 0.2 mg/kg. After the patients with intubation condition, tracheal intubation was performed under visual laryngoscopy, and the anesthesia machine was connected for mechanical ventilation. Normal ventilator parameters were set according to the patient’s condition, and the partial pressure of carbon dioxide at the end of respiration was maintained at 35–45 mmHg. Intraoperatively, cis-atracurium was added intermittently. Anesthesia maintenance: MAC sevoflurane (National Medical Products Administration No. H20070172) 1.0–3.0 mg was used, propofol 2–6 mg/(kg-h) and remifentanil (National Medical Products Administration No. H20123422 ) 0.1-2 µg/ (kg-min) were pumped intravenously, and intraoperative BIS value was maintained at 40–60. To control blood pressure lowering was implemented according to the needs of surgery, with a target blood pressure 20% reduction of the basal level. If necessary, nitroglycerin was used for hypotension. General anesthesia drugs were discontinued near the end of surgery. Postoperative data was collected by an anesthesiologist specializing in data collection. Neither the anesthesiologist nor the physician was aware of the patients when the data was collected. Collection of indicators The scores of VAS, HAMD, HAMA, CD-RISC, and SNOT-20 were tested preoperatively and on days 1, 3, 5, and 9 postoperatively, respectively; before and after the PSQI scores treatments all general data including age, gender, BMI, underlying disease, surgical time, anesthesia time, and course of disease were collected(see Fig. 1). In the PSQI all patients’ sleep were evaluated [ 14 ] , including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, used sleep medication, and daytime dysfunction, he sum of these 7scores ranges from 0 to 21 with higher scores for poorer sleep quality. The scores of 0–5, 6–10, 11–15, 16–21 indicate very good, good, fair, and very poor sleep quality, respectively. The HAMD scale consists of 24 items and 7 types of factors: anxiety/somatization, body mass, cognitive impairment, diurnal variation, retardation, sleep disturbance, and hopelessness. The total scores of > 35, 21–35, 8–20, and < 8 were classified as severe, mild-moderate, critical, and no depression [ 15 ] . The HAMA was used to assess patients’ anxiety symptoms before and after nursing. The scores of < 7, 7–14, 14–21, 21–29, and ≥ 29 represent no anxiety symptoms and psychologically normal, possible anxiety, definite anxiety, definite and significant anxiety, and severe anxiety symptoms, respectively. The score is inversely proportional to the anxiety symptoms, for example the lower the score, the less severe the anxiety symptoms [ 16 ] . The CD-RISC was utilized to assess the level of psychological resilience of patients, including 5 dimensions of tolerating negative emotions (0–10 points), positive acceptance of change (0–10 points), personal competence (0–10 points), control (0–10 points), and religious belief (0–10 points), with a total of 25 items. A 5-point scale (0–4 points) was used, with a total score of 0 to 100 points. A higher score indicates better psychological resilience [ 17 ] . The SNOT-20 was employed to assess the life quality of the patients, consisting of 20 symptoms in 3 dimensions: physical problems, functional limitations, and emotional outcomes. Respondents were asked to rate 20 symptoms based on their sinusitis symptoms. The scores of 0, 1, 2, and 3 mean no distress, mild distress, moderate distress, and severe distress to the respondent, respectively. The higher the total scores of 20 symptoms, the poorer the life quality of the respondent. Finally, the respondents were asked to select the most five important symptoms for themselves out of 20 symptoms [ 18 ] . The VAS score was used to rate pain before and after treatment. The score was positively correlated to the level of pain. The scores of 0, ≤ 3, 4–6, and ≥ 7 indicate no pain, mild pain, moderate pain, and severe pain, respectively [ 19 ] . Statistical analysis All data in this study was statistically processed with the SPSS 26.0 statistical software. The normality test was performed using the K-S method. Normally distributed measurement data were expressed as (x ± s), and ANOVA was used for the comparison of means between groups; the repeated measures data were analyzed by the repeated measures ANOVA, and the SNK method was used to compare groups; data were expressed as frequency ( n ) or rate (%); χ 2 test was used for data that met the conditions and the Fisher exact probability method for those that did not. Moreover, skewed distribution data were compared using the Kruskal-Walis H rank sum test with test level α = 0.05. Results Comparison of general data Table 1 shows that the 0.3 mg group had 45 cases, including 32 males and 13 females, with a mean age of 44.34 ± 4.11 years and a mean disease duration of 9.76 ± 8.98 years; the 0.2 mg group had 45 cases, including 31 males and 14 females, with a mean age of 43.92 ± 5.12 years and a mean disease duration of 11.34 ± 8.33 years; he control group also had 45 cases, including 32 males and 13 females, with a mean age of 44.33 ± 5.31 years and a mean disease duration of 11.46 ± 8.74 years. No statistically significant difference between the three groups was observed in terms of gender, age, BMI, underlying disease, surgical time, anesthesia time, awakening time, course of disease, and ASA grading (all P > 0.05). Table 1 Comparison of general data of the three groups Item 0.3 mg group (n = 45) 0.2 mg group (n = 45) Control group (n = 45) χ 2 / F value P value Gender (male/female) 32/13 31/14 32/13 0.071 0.965 Age (yrs, x ± s) 44.34 ± 4.11 43.92 ± 5.12 44.33 ± 5.31 0.456 0.663 BMI (kg/m 2 , x ± s) 24.46 ± 3.20 23.32 ± 2.41 22.98 ± 2.87 0.768 0.512 Underlying disease (cases) - 1.000 Hypertension 1 1 2 Diabetes mellitus 0 1 1 Surgical time (min, x ± s) 111.76 ± 34.33 121.81 ± 22.98 117.31 ± 21.34 1.112 0.201 Anesthesia time (min, x ± s) 155.45 ± 33.34 163.57 ± 31.45 166.47 ± 31.47 0.982 0.302 Awakening time (min, x ± s) 18.42 ± 6.05 22.34 ± 7.18 17.33 ± 6.21 0.957 0.306 Course of disease (yrs, x ± s) 9.76 ± 8.98 11.34 ± 8.33 11.46 ± 8.74 0.911 0.315 ASA classification 0.667 0.716 I 38 36 35 II 7 9 10 BMI: body mass index; ASA: American Society of Anesthesiologists Analysis of PSQI, HAMD, and HAMA scores For the effect of different treatments on patients’ HAMD and HAMA scores within 9 days, the data in each group stood by an approximately normal distribution ( P > 0.05) and an equal variance-covariance matrix ( P > 0.05, data expressed as x ± s). Table 2 shows that the interaction between HAMD and HAMA score time*treatment was significant in three groups ( F HAMD score interaction =78.318, F HAMA score interaction =67.312, both P < 0.05), which indicates different individual effect sizes for the four categories of postoperative scores at the four-time points in patients treated with different concentrations of esketamine. All four categories of scores decreased over time in all three groups ( F HAMDscore time =67.932, F HAMAscore time =55.482, both P < 0.05), indicating distinct changes in the magnitude of HAMD and HAMA scores over time. Moreover, different esketamine concentrations had different effects on HAMD and HAMA scores ( F HAMDscore treatment =59.593, F HAMAscore treatment =71.479, both P < 0.05). A two-by-two scores comparison on days 1, 3, 5, and 9 revealed that all three groups had the same order for the magnitude of the HAMD and HAMA scores at the four-time points: the control group > the 0.2 mg group > the 0.3 mg group. Table 2 Comparison of HAMD and HAMA scores in the three groups Item Time 0.3 mg group (n = 45) 0.2 mg group (n = 45) Control group (n = 45) F interaction / P interaction value F time / P time value F treatment / P treatment value HAMD (points, x ± s) Baseline b 26.53 ± 5.41 27.12 ± 5.53 26.48 ± 5.42 78.318/0.001 67.932/0.001 59.593/0.001 1d a 23.11 ± 3.14 24.89 ± 2.31 25.88 ± 3.11 3d a 19.17 ± 3.21 21.45 ± 2.47 23.10 ± 2.78 5d a 15.45 ± 3.14 18.01 ± 2.45 20.56 ± 2.65 9d a 11.46 ± 2.43 14.38 ± 2.11 16.56 ± 2.87 HAMA (points, x ± s) Baseline b 25.21 ± 3.65 24.69 ± 3.98 25.74 ± 4.32 67.312/0.001 55.482/0.001 71.479/0.001 1d a 22.11 ± 2.31 23.12 ± 3.21 24.45 ± 3.17 3d a 20.46 ± 2.45 21.67 ± 3.10 22.98 ± 2.89 5d a 18.55 ± 2.98 19.45 ± 2.78 20.59 ± 2.67 9d a 15.45 ± 2.65 19.37 ± 2.21 23.74 ± 2.52 HAMD: Hamilton Depression Scale, HAMA: Hamilton Anxiety Scale; a: statistically significant difference between the three groups; b: no statistically significant difference between the three groups A statistically significant PSQI score difference was observed between the three groups after treatment (3.31 ± 0.21 VS 6.47 ± 0.54 VS 9.31 ± 0.31 points, F = 43.142, P the 0.2 mg group > the 0.3 mg group (Table 3 ). Table 3 Comparison of PSQI scores in the three groups Item Time 0.3 mg group (n = 45) 0.2 mg group (n = 45) Control group (n = 45) F value P value PSQI (points, x ± s) Baseline 17.38 ± 3.48 18.48 ± 3.21 18.47 ± 2.47 0.713 0.583 Post-treatment 3.31 ± 0.21 6.47 ± 0.54 9.31 ± 0.31 43.142 < 0.001 PSQI: Pittsburgh Sleep Quality Index Analysis of CD-RISC, SNOT-20, and VAS scores For the effect of different treatments on patients’ CD-RISC, SNOT-20, and VAS scores within 9 days, the data in each group obeyed an approximately normal distribution ( P > 0.05) and an equal variance-covariance matrix between the groups ( P > 0.05, data expressed as x ± s). Table 4 shows that the interactions of CD-RISC, SNOT-20, and VAS score time*treatment were significant in all three groups ( F CD−RISC score interaction =56.149, F SNOT−20 score interaction =98.418, F VASscore interaction =89.492, both P < 0.05), indicating different individual effect sizes in the three categories of postoperative scores at the four-time points in patients treated with different esketamine concentrations. All four categories of scores decreased over time in all three groups ( F CD−RISCscore time =76.298, F SNOT−20score time =68.482, F VASscore time =71.483, both P < 0.05), indicating the distinct changes in magnitude of these three categories of scores over time. Moreover, different concentrations of esketamine s had different effects on the CD-RISC, SNOT-20, and VAS scores ( F CD−RISCscore treatment =65.549, F SNOT−20score treatment =66.429, F VASscore treatment =56.73, both P the 0.2 mg group > the 0.3 mg group; and the CD-RISC scores were in the same order for magnitude at the four-time points: the control group < the 0.2 mg group < the 0.3 mg group. Table 4 Comparison of CD-RISC, SNOT-20, and VAS scores in the three groups Item Time 0.3 mg group (n = 45) 0.2 mg group (n = 45) Control group (n = 45) F interaction / P interaction value F time / P time value F treatment / P treatment value CD-RISC (points, x ± s) Baseline b 40.53 ± 9.42 40.45 ± 9.63 41.34 ± 9.87 56.149/0.001 76.298/0.001 65.549/0.001 1d a 52.38 ± 9.41 48.47 ± 11.31 45.82 ± 8.39 3d a 66.46 ± 9.46 53.67 ± 10.54 50.46 ± 8.56 5d a 76.49 ± 10.43 65.65 ± 8.47 55.67 ± 9.32 9d a 85.37 ± 12.48 76.45 ± 13.69 59.75 ± 13.43 SNOT-20 (points, x ± s) Baseline b 22.15 ± 6.42 23.74 ± 5.45 23.33 ± 5.24 98.418/0.001 68.482/0.001 66.429/0.001 1d a 19.33 ± 5.47 20.12 ± 5.92 21.45 ± 5.45 3d a 15.12 ± 3.47 16.46 ± 3.45 18.33 ± 4.31 5d a 12.45 ± 2.64 14.58 ± 2.31 15.48 ± 2.47 9d a 9.36 ± 2.14 11.17 ± 3.47 12.98 ± 2.39 VAS (points, x ± s) Baseline b 7.82 ± 2.21 7.92 ± 1.83 7.77 ± 1.69 89.492/0.001 71.483/0.001 56.73/0.001 1d a 5.69 ± 2.10 6.56 ± 1.87 7.10 ± 1.01 3d a 4.24 ± 1.34 5.43 ± 0.58 6.34 ± 0.79 5d a 3.23 ± 1.21 4.45 ± 0.61 5.23 ± 0.68 9d a 1.21 ± 0.67 2.55 ± 0.54 3.67 ± 0.32 CD-RISC: Connor-Davidson Resilience Scale; SNOT-20: Sino-nasal Outcome Test-20; VAS: Visual Analogue Scale; a: statistically significant difference between the three groups, b: no statistically significant difference between the three groups Discussion Pain, a painful response and an unpleasant emotional sensation that the organism experiences in response to injurious stimuli is the fifth vital sign after temperature, pulse, respiration, and blood pressure [ 20 ] . Postoperative pain, as an acute pain occurring rapidly after surgical injury to tissues, has a close bearing on the magnitude of surgical trauma, and the degree of inflammatory response especially excessive stress can be detrimental to the organism to a certain extent. Additionally, it may cause internal environmental and metabolic disorders in the organism and lead to gastrointestinal dysfunction, which seriously affects patients, especially in some elderly and frail patients, sleep, diet, and organ dysfunction [ 21 ] . Postoperative pain, anxiety, and tension easily lead to fluctuations in hormone levels [ 22 ] , which is not conducive to a good recovery after surgery, and it also is the primary reason for patients' delayed discharge from the hospital. Patients with endoscopic sinus surgery experience a period of pain in which local anesthetic infiltration or local packing does not adequately relieve postoperative pain, and other analgesic drugs are yet to be used [ 23 ] . Esketamine, an isomer of ketamine, produces analgesic, sedative, and amnestic, plays mainly its role in anti-inflammatory and antidepressant by blocking N-methyl-D-aspartate (NMDA) receptors [ 24 ] . Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for clinical relief of osteoarthritis, rheumatoid arthritis, and various pain symptoms but some adverse reactions also accompany, such as gastric mucosal lesions, gastric bleeding, and liver and kidney function. Esketamine and NSAIDs are not identical in their mechanism of action and target point. Their combined application can synergistically increase a patient’s pain threshold, and reduce pain sensation and inflammatory response, which effectively reduces some clinical symptoms such as nociceptive hypersensitivity with favorable efficacy. The SNOT-20 and VAS, as chronic sinusitis-specific QOL measurement scales, have been extensively applied worldwide, with the advantages of “depth and sensitivity”. The 20 symptoms of SNOT-20 have a close bearing on chronic sinusitis [ 25 ] . The scale is highly targeted for sinus-related disorders, focusing on nose-related symptoms and covering physical problems, social functioning, and emotional outcomes. Its items are simple and easily understood, with a greater practicality. The VAS scale is able to intuitively reflect patients' severity of their disease [ 26 ] . In this study, the SNOT-20 and VAS scores of those who used esketamine were lower than those who did not, which is consistent with previous literature reports to the efficacy of esketamine in effective pain relief and life quality improvement [ 26 – 27 ] . Depression is caused by clustered discharges in the “anti-reward center” of the lateral rein nucleus, which strengthens the inhibitory effect of the lateral rein nucleus on the “reward center” of the monoamine nucleus in the midbrain. Esketamine achieves antidepression by blocking the clustered firing of these reinnucleus neurons and eliminating their inhibitory effect on the reward center [ 28 – 29 ] ; it has a high affinity for the N-methyl-D-aspartate receptor where the main mechanism involves the sustained selective blockade of the subtypes of NMDA receptor, leading to dephosphorylation of eEF2 and increased expression of trotomyosin receptor kinase B (TrkB). In this way, esketamine ultimately acts by increasing the release of neurotrophic factors to improve neuroplasticity and synapse formation [ 30 ] . Perioperative anxiety is mostly caused by the disease itself, surgical anesthesia, and other factors. It is accompanied by hemodynamic abnormalities involving the sympathetic and parasympathetic nervous systems, and the endocrine system, and it can be manifested as restlessness, fatigue, inattention, and muscle tension [ 31 ] . The mechanism of esketamine on antianxiety possibly includes its superior affinity for NMDA receptors and opioid receptors, which may synergize sedation and further reduce the pain and inflammatory state in the perioperative period [ 32 ] . Patients who used esketamine had lower HAMA and HAMD scores than those who did not, which suggests that esketamine is effective in relieving anxiety and depression in patients. Following FESS, the abundant nerve endings in the nasal cavity, will be compressed by the tamponade, then to irritate the mucosal tissues of the nasal cavity and sinuses, and cause pain and discomfort in the nasal and frontal regions, dyspnea, and hypoxia. Patients suffering from such diseases are prone to difficulty falling asleep and waking up easily from sleep suffocation, irritability, and anxiety [ 33 ] . It has been reported that those sleep problems in patients with FESS severely affect their sleep quality and recovery after surgery [ 34 ] . Chronic poor sleep also causes psychological resilience and poor psychological maturity [ 35 ] . We showed that the CD-RISC and PSQI scores of those who used esketamine were higher than those who did not, indicating the efficacy of esketamine in effective relief to anxiety and depression. Nevertheless, there are limitations to this study. First, the small size of the samples limited our findings, which should be further expanded in the future. Second, no long-term follow-up was conducted and the related effect of intervention should also be judged in follow-up. Finally, multiple variable factors were found to influence the efficacy of nasal endoscopic surgery in combination, which is possibly due to individualized differences. Nevertheless, the relationship between these suspected influencing factors and the efficacy of nasal endoscopic surgery should provide guidance for clinical treatment in chronic sinusitis. Conclusion Small doses of esketamine reduce postoperative anxiety and depression in patients with sinus surgery, relieve symptoms, and improve the quality of sleep. Declarations Ethics approval and consent to participate Not required ethics approval, patient identifiers, and patient consent for publication because the study data included in this study were de-identified. All methods in this study were carried out in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) guidelines. Consent for publication Not applicable. Availability of data and materials Data used in this analysis are available from. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Guangzhou Municipal Science and Technology Project (2023A03J0508 and 2024A03J00721). The funders had no role in the study design, data collection or analysis, or preparation of the manuscript. Authors’ contributions YPZ and ZF contributed to the conception and design of the study. YPZ, JCL , CL, and XSF organized the database, performed the statistical analysis, and drafted the initial manuscript. ZF critically revised the manuscript and provided project administration. All authors gave final approval for publication. References Shi Yafang. Clinical efficacy of functional endoscopic sinus surgery for chronic sinusitis and its impact on patients’ quality of life[J]. J Med Forum. 2017;38(7):117–8. Rula S. Song Lihua. Research on the clinical treatment of chronic sinusitis[J]. World Latest Med Inform. 2019;19(94):107–12. 10.19613/j.cnki.1671-3141.2019.94.066 . Liu Xiaoxia C. Clinical report on functional partial turbinate resection for 38 cases of chronic sinusitis with nasal polyps[J]. Electron J Clin Med Literature. 2019;6(47):15–6. 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Huang Y, Huang Y, Lin M, et al. Seeking central hopelessness symptoms which direct link to resilience among parents of children with autism spectrum disorder in China-A network perspective. Psych J. 2023 Nov;9. 10.1002/pchj.707 . Piccirillo JF, Merritt MG Jr, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg. 2002;126(1):41–7. 10.1067/mhn.2002.121022 . Bodian CA, Freedman G, Hossain S et al. The visual analog scale for pain: clinical significance in postoperative patients[J].Anesthesiology,2001,95(6):1356–6110.1097/00000542-200112000-00013. Wei Jianmei W, Jianning C, Ying, et al. Research and application of pain assessment and management standards[J]. Jiangxi Med J. 2019;54(06):714–6. 10.3969/j.issn.1006-2238.2019.6.047 . Xie Peng L, Haiying X, Jing, et al. Effects of flurbiprofen axetil combined with dezocine on hemodynamics and postoperative analgesia effects in patients undergoing radical resection of colon cancer[J]. Hebei Med. 2019;25(08):1284–8. 10.3969/j.issn.1006-6233.2019.08.014 . Guo Yue Z, Tiyu Y, Chunzi, et al. The efficacy of preoperative education on pain relief in patients undergoing hip or knee replacement: a meta-analysis[J]. J Nurs Sci. 2015;30(12):105–9. 10.3870/hlxzz.2015.12.105 . Friedman M, Venkatesan TK, Lang D et al. Bupivacaine for postoperative analgesia following endoscopic sinus surger-y. Lary ngoscope 1996,106 :1382 ~ 1385. 10.1097/00005537-199611000-00014 . Vines L, Sotelo D, Johnson A, et al. Ketamine usedisorder: preclinical, clinical, and neuroimagingevidence to support proposed mechanisms of actions[J]. Intell Med. 2022;2(2):61–8. 10.1016/j.imed.2022.03.001 . Zuo Kejun X, Geng S. Quality of life survey on patients with chronic rhinosinusitis and nasal polyps[J]. Chin J Otorhinolaryngol Head Neck Surg. 2006;4(10):748–52. 10.3760/j.issn:1673-0860.2006.10.007 . Zhang Chun C, Jie J. Study on quality of life in patients with chronic sinusitis as assessed by of SNOT-20,VAS and SF-36[J]. Chongqing Med. 2008;37(12):1319–24. 10.3969/j.issn.1671-8348.2008.12.028 . Wang Hanhuan W, Lixin W, Kaibin. Effect of low dose esketamine on postoperative anxiety and depression in patients undergoing sinus surgery[J]. China Foreign Med Treat. 2023;42(15):138–42. 10.16662/j.cnki.1674-0742.2023.15.138 . Zhou X, Zhang C, Miao J et al. The Sustained Antidepressant Effects of Ketamine Are Independent of the Lateral Habenula[J].J Neurosci,2021,41(18):4131–4010.1523/JNEUROSCI.2521-20.2021. Takenaka S, Hirose M. Preoperative Anxiety and Intra⁃operative Nociception in Patients Undergoing Thoracic Surgery[J]. J Surg Res. 2020;249:13–7. 10.1016/j.jss.2019.12.017 . Zhao Wenli Q, Weiling YL, et al. A antidepressant of new mechanism: esketamine[J]. Chin J New Drugs Clin Remedies. 2019;38(10):585–8. 10.14109/j.cnki.xyylc.2019.10.002 . Gong Ruisong Z, Jing. Research progress on perioperative anxiety [J]. Beijing Med J. 2018;40(6):572–4. Li F. Application progress of non-opioid analgesics in perioperative period[J]. Syst Med. 2021;6(2):195–8. 10.19368/j.cnki.2096-1782.2021.02.195 . Kang Danhong Y, Lina Y, Chenlin, et al. Comparison of the effects of respiratory training and cold compress on improving the comfort of patients with nasal packing[J]. Shanxi Med J. 2017;46(6):729–31. 10.3969/j.issn.0253-9926.2017.06.049 . Xueliang L, Gang L. Clinical observation of budesonide nasal spray in the treatment of chronic rhino-sinusitis complicating with allergic rhinitis after endoscopic sinus surgery[J]. Chin Pharm. 2017;28(2):215–9. 10.6039/j.issn.1001-0408.2017.02.19 . Cai H, Guo J, Zhou J, et al. Psychological resilience mediates the association between sleep quality and anxiety symptoms: A repeated measures study in college students. PLoS ONE. 2023;18(10):e0292887. 10.1371/journal.pone.0292887 . Additional Declarations No competing interests reported. Supplementary Files Rawdata.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3982476","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276131585,"identity":"9835f74a-6b87-4677-bb5f-820228bf8616","order_by":0,"name":"Yan-ping Zhao","email":"","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yan-ping","middleName":"","lastName":"Zhao","suffix":""},{"id":276131586,"identity":"6777ab42-b292-4ad0-9cff-296d9ad37950","order_by":1,"name":"Ji-can Lu","email":"","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ji-can","middleName":"","lastName":"Lu","suffix":""},{"id":276131587,"identity":"1fac0ef8-f270-4c79-8bfd-3b131e379c8f","order_by":2,"name":"Chao Liu","email":"","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Liu","suffix":""},{"id":276131588,"identity":"7030efec-8af6-4631-891d-84a191a3e25f","order_by":3,"name":"Xun-si Fu","email":"","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xun-si","middleName":"","lastName":"Fu","suffix":""},{"id":276131589,"identity":"21f38f04-74e1-496a-9cd3-01fe6f95a965","order_by":4,"name":"Yan Jia","email":"","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Jia","suffix":""},{"id":276131590,"identity":"ebe453d6-96ee-441f-a12d-aae7489129ed","order_by":5,"name":"Feng Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCcaGDyDagIH5GFiAjZ2wlsYZEC1saQwMCUAtzAS1MDBCtfCYgbUwENLCP7u5seHjjlp7c4mcbw8+/tgmz8fMwPjhYw4eS+4cbGyceeY4s+WM3O2GMxJuG7YxMzBLztyGW4uBRGL7Y962Y2wGN3K3SfMk3GYEamFj5sWvpbH5b9sxHoMbOc9AWuyJ08LYViMB1MIG0pJIUIvEjcTGxt62AwYGZ56ZSc5Iu53cxszYjNcv/DPSHzb8bKuzNzie/Ezig81t2/ntzQc/fMSjBQoOI3MYGwiqB4I6YhSNglEwCkbBSAUALx9R1XgmRxEAAAAASUVORK5CYII=","orcid":"","institution":"Guangzhou Twelfth People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Feng","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2024-02-23 16:15:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3982476/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3982476/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52103898,"identity":"e80e0e20-3376-43e6-8c91-cd7e2d5bd521","added_by":"auto","created_at":"2024-03-06 19:21:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":107979,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3982476/v1/8f2f2dcf2781859358ad244b.png"},{"id":61726465,"identity":"47a98f60-d62c-4f8c-8241-a42a2b848881","added_by":"auto","created_at":"2024-08-04 18:46:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":819308,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3982476/v1/4fa9a560-faa2-47b5-b3b2-411930617f2d.pdf"},{"id":52103899,"identity":"927e29c3-de4a-4dd2-b902-963ee2f05a03","added_by":"auto","created_at":"2024-03-06 19:21:53","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34288,"visible":true,"origin":"","legend":"","description":"","filename":"Rawdata.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3982476/v1/0c532e01be4728d16b9637e8.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improvement and clinical benefit analysis of low-dose ketamine on postoperative pain and sleep after sinus surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe increased incidence of sinusitis has been witnessed in recent years as results of the contaminated environment and the increased social pressure. Chronic sinusitis (CRS), with a prevalence of 5\u0026ndash;15%, has become one of the most common and frequently occurring diseases in otolaryngology \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It has been considered a serious public health problem due to severe interference with patients\u0026rsquo; work and lives and lowering their survival quality \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Drug therapy alone is ineffective in CRS because of a high recurrence rate. Conventionally, nasal endoscopic surgery has been used for CRS treatment, with accompanying extensive invasive surfaces and multiple postoperative complications. As a result, this procedure in the clinic has gradually been eliminated. Functional endoscopic sinus surgery (FESS) thoroughly removes diseased tissues and restores normal morphology and physiological function of nasal and sinus mucosa \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. FESS, characterized by small trauma, a clear operative field, and a broad surgical perspective, has been regarded as a preferred surgical technique for the treatment of CRS \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Although FESS causes tremendous pain in breathing, swallowing, and other postoperative maneuvers due to the anatomical structure of the surgical site and the peculiarities of physiological functions, such as postoperative head and face pain, especially in those with nasal packing and mainly manifests as nasal distension, and most in the whole head which seriously affects their sleep and diet \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In fact, all patients experienced varying degrees of pain after FESS\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e that even those with routine postoperative analgesia still had degrees of pain (VAS\u0026thinsp;\u0026ge;\u0026thinsp;5\u0026ndash;6) at different periods after surgery (especially at 6h and 24h postoperatively), which proves that the effectiveness and safety of postoperative analgesia for FESS patients are of paramount importance. Opioids undoubtedly work better for analgesia but traditionally triggered adverse reactions such as skin itching, dizziness, nausea, and vomiting \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e; therefore, it has become a common challenge for otolaryngologists and anesthesiologists to find an effective method of postoperative analgesia.\u003c/p\u003e \u003cp\u003eEsketamine, also known as dextroketamine currently used as a common anesthetic drug, is the only intravenous anesthetic with mild respiratory effects that provides sedation, analgesia, and anesthesia. Recent studies \u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e have demonstrated that subanesthetic doses of dexketamine cause favorable analgesia while reducing intraoperative or postoperative propofol and opioid dosage, contributing to smoother intraoperative hemodynamics, in which those, prophylactically infused 0.5 mg/kg of dexketamine at 2 \u0026micro;g/kg/min continuously for 12 h after cesarean section, were proved to be safe and some antinociceptive sensitization effects \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e; those with continuous intravenous pumping of dextroketamine at 0.3 mg/kg/h during laparoscopic cholecystectomy was beneficial in decreasing morphine usage \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Additionally, esketamine can improve the objective sleep percentage of postoperative slow wave sleep (SWS) in patients undergoing gynecologic open surgery \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, it can also safely apply for postoperative analgesia to alleviate pain and discomfort to a certain extent improvement of sleep quality. However, postoperative analgesia and improvement of sleep after the application of esketamine in patients with FESS are still in the exploratory stage, in which a small size sample for the relationship between dose and efficacy is common to limit our acknowledgement. Here, we based on the entry point of esketamine patients\u0026rsquo; postoperative pain to reduce the usage of opioids and patients\u0026rsquo; adverse reactions and explored its effect on the improvement of pain, sleep, and quality of life in patients with FESS.\u003c/p\u003e"},{"header":"Study subjects and methods","content":"\u003cp\u003e \u003cem\u003eStudy subjects\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOne hundred and thirty-five patients who suffered from sinusitis and underwent functional endoscopic sinus surgery in the Guangzhou Twelfth People's Hospital between June 2018 and September 2023 were recruited and were randomly and equally divided into three groups using \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ethe random number table method\u003c/span\u003e \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e: 0.2 mg (n\u0026thinsp;=\u0026thinsp;45), 0.3 mg (n\u0026thinsp;=\u0026thinsp;45), and control (n\u0026thinsp;=\u0026thinsp;45). The inclusion criteria were as follows: (1) patients with complete medical records; (2) those without severe cardiovascular, respiratory, hepatic or renal diseases; (3) those with a preoperative American Society of Anesthesiologists (ASA) classification of I to III; (4) those who were 18\u0026ndash;70 years old; (5) those without hormones and immunosuppressant used before surgery; (6) those whose operation time was 8\u0026ndash;17 o\u0026rsquo;clock; (7) those without a history of pepticulcer disease; (8) those without a history of addiction to analgesic drugs; (9) those without a history of migraine disease; (10) those who could cooperate with physical examination and pain assessment. The exclusion criteria were as follows: (1) those with an operative time of \u0026lt;\u0026thinsp;60 min or \u0026gt;\u0026thinsp;180 min; (2) those with an operative bleeding volume of 20\u0026ndash;200 ml; (3) those with intraoperative and postoperative allergic reactions; (4) those without cooperating with postoperative treatment and follow-up visits; (5) those with the developed severe infections after surgery; and (6) psychiatric patients.\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee of our hospital under the ethical number 2024019. All the study subjects signed an informed consent form.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy methods\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePrior to induction, control, 0.2 mg/kg, and 0.3 mg/kg esketamine were injected intravenously into 3 ml of saline, 0.2 mg/kg esketamine (prepared in saline to 3 ml), and 0.3 mg/kg esketamine (prepared in saline to 3 ml), respectively. The specific anesthesia methods are shown below: all enrolled patients were administered general anesthesia by the same group of anesthesiologists. The volume of 3 ml esketamine (National Medical Products Administration No. H20193336) and an equal amount of saline were prepared by the nurse anesthetist before anesthesia, and then sterile syringes containing 3 ml of prepared esketamine or saline were distributed to the anesthesiologists. Anesthesia induction: anesthesia was performed by injecting remimazolam tosylate (National Medical Products Administration No. H20190034) 0.1mg/kg propofol medium/long-chain fat emulsion injection (National Medical Products Administration No. H20203571) \u003cb\u003e1\u0026ndash;2\u003c/b\u003e mg/kg, sufentanil (\u003cb\u003eNational Medical Products Administration No. H20054171\u003c/b\u003e) 0.5 \u0026micro;g/kg, and cis-atracurium (National Medical Products Administration No. H20183042) 0.2 mg/kg. After the patients with intubation condition, tracheal intubation was performed under visual laryngoscopy, and the anesthesia machine was connected for mechanical ventilation. Normal ventilator parameters were set according to the patient\u0026rsquo;s condition, and the partial pressure of carbon dioxide at the end of respiration was maintained at 35\u0026ndash;45 mmHg. Intraoperatively, cis-atracurium was added intermittently. Anesthesia maintenance: MAC sevoflurane (National Medical Products Administration No. H20070172) 1.0\u0026ndash;3.0 mg was used, propofol \u003cb\u003e2\u0026ndash;6\u003c/b\u003e mg/(kg-h) and remifentanil (National Medical Products Administration No. \u003cb\u003eH20123422\u003c/b\u003e) 0.1-2 \u0026micro;g/ (kg-min) were pumped intravenously, and intraoperative BIS value was maintained at 40\u0026ndash;60. To control blood pressure lowering was implemented according to the needs of surgery, with a target blood pressure 20% reduction of the basal level. If necessary, nitroglycerin was used for hypotension. General anesthesia drugs were discontinued near the end of surgery. Postoperative data was collected by an anesthesiologist specializing in data collection. Neither the anesthesiologist nor the physician was aware of the patients when the data was collected.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCollection of indicators\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe scores of VAS, HAMD, HAMA, CD-RISC, and SNOT-20 were tested preoperatively and on days 1, 3, 5, and 9 postoperatively, respectively; before and after the PSQI scores treatments all general data including age, gender, BMI, underlying disease, surgical time, anesthesia time, and course of disease were collected(see Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eIn the PSQI all patients\u0026rsquo; sleep were evaluated \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, used sleep medication, and daytime dysfunction, he sum of these 7scores ranges from 0 to 21 with higher scores for poorer sleep quality. The scores of 0\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;15, 16\u0026ndash;21 indicate very good, good, fair, and very poor sleep quality, respectively.\u003c/p\u003e \u003cp\u003eThe HAMD scale consists of 24 items and 7 types of factors: anxiety/somatization, body mass, cognitive impairment, diurnal variation, retardation, sleep disturbance, and hopelessness. The total scores of \u0026gt;\u0026thinsp;35, 21\u0026ndash;35, 8\u0026ndash;20, and \u0026lt;\u0026thinsp;8 were classified as severe, mild-moderate, critical, and no depression \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe HAMA was used to assess patients\u0026rsquo; anxiety symptoms before and after nursing. The scores of \u0026lt;\u0026thinsp;7, 7\u0026ndash;14, 14\u0026ndash;21, 21\u0026ndash;29, and \u0026ge;\u0026thinsp;29 represent no anxiety symptoms and psychologically normal, possible anxiety, definite anxiety, definite and significant anxiety, and severe anxiety symptoms, respectively. The score is inversely proportional to the anxiety symptoms, for example the lower the score, the less severe the anxiety symptoms \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe CD-RISC was utilized to assess the level of psychological resilience of patients, including 5 dimensions of tolerating negative emotions (0\u0026ndash;10 points), positive acceptance of change (0\u0026ndash;10 points), personal competence (0\u0026ndash;10 points), control (0\u0026ndash;10 points), and religious belief (0\u0026ndash;10 points), with a total of 25 items. A 5-point scale (0\u0026ndash;4 points) was used, with a total score of 0 to 100 points. A higher score indicates better psychological resilience \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe SNOT-20 was employed to assess the life quality of the patients, consisting of 20 symptoms in 3 dimensions: physical problems, functional limitations, and emotional outcomes. Respondents were asked to rate 20 symptoms based on their sinusitis symptoms. The scores of 0, 1, 2, and 3 mean no distress, mild distress, moderate distress, and severe distress to the respondent, respectively. The higher the total scores of 20 symptoms, the poorer the life quality of the respondent. Finally, the respondents were asked to select the most five important symptoms for themselves out of 20 symptoms \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe VAS score was used to rate pain before and after treatment. The score was positively correlated to the level of pain. The scores of 0, \u0026le;\u0026thinsp;3, 4\u0026ndash;6, and \u0026ge;\u0026thinsp;7 indicate no pain, mild pain, moderate pain, and severe pain, respectively \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll data in this study was statistically processed with the SPSS 26.0 statistical software. The normality test was performed using the K-S method. Normally distributed measurement data were expressed as (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and ANOVA was used for the comparison of means between groups; the repeated measures data were analyzed by the repeated measures ANOVA, and the SNK method was used to compare groups; data were expressed as frequency (\u003cem\u003en\u003c/em\u003e) or rate (%); \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e test was used for data that met the conditions and the Fisher exact probability method for those that did not. Moreover, skewed distribution data were compared using the \u003cem\u003eKruskal-Walis H\u003c/em\u003e rank sum test with test level \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cem\u003eComparison of general data\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that the 0.3 mg group had 45 cases, including 32 males and 13 females, with a mean age of 44.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11 years and a mean disease duration of 9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98 years; the 0.2 mg group had 45 cases, including 31 males and 14 females, with a mean age of 43.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12 years and a mean disease duration of 11.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33 years; he control group also had 45 cases, including 32 males and 13 females, with a mean age of 44.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31 years and a mean disease duration of 11.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74 years. No statistically significant difference between the three groups was observed in terms of gender, age, BMI, underlying disease, surgical time, anesthesia time, awakening time, course of disease, and ASA grading (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general data of the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e/\u003cem\u003eF\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (yrs, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderlying disease (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time (min, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111.76\u0026thinsp;\u0026plusmn;\u0026thinsp;34.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121.81\u0026thinsp;\u0026plusmn;\u0026thinsp;22.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117.31\u0026thinsp;\u0026plusmn;\u0026thinsp;21.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia time (min, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155.45\u0026thinsp;\u0026plusmn;\u0026thinsp;33.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.57\u0026thinsp;\u0026plusmn;\u0026thinsp;31.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166.47\u0026thinsp;\u0026plusmn;\u0026thinsp;31.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwakening time (min, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.42\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of disease (yrs, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBMI: body mass index; ASA: American Society of Anesthesiologists\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cem\u003eAnalysis of PSQI, HAMD, and HAMA scores\u003c/em\u003e\u003c/p\u003e \u003cp\u003eFor the effect of different treatments on patients\u0026rsquo; HAMD and HAMA scores within 9 days, the data in each group stood by an approximately normal distribution (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and an equal variance-covariance matrix (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, data expressed as x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the interaction between HAMD and HAMA score time*treatment was significant in three groups (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMD score interaction\u003c/em\u003e\u003c/sub\u003e=78.318, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMA score interaction\u003c/em\u003e\u003c/sub\u003e=67.312, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), which indicates different individual effect sizes for the four categories of postoperative scores at the four-time points in patients treated with different concentrations of esketamine. All four categories of scores decreased over time in all three groups (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMDscore time\u003c/em\u003e\u003c/sub\u003e=67.932, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMAscore time\u003c/em\u003e\u003c/sub\u003e=55.482, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating distinct changes in the magnitude of HAMD and HAMA scores over time. Moreover, different esketamine concentrations had different effects on HAMD and HAMA scores (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMDscore treatment\u003c/em\u003e\u003c/sub\u003e=59.593, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMAscore treatment\u003c/em\u003e\u003c/sub\u003e=71.479, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A two-by-two scores comparison on days 1, 3, 5, and 9 revealed that all three groups had the same order for the magnitude of the HAMD and HAMA scores at the four-time points: the control group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.2 mg group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.3 mg group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of HAMD and HAMA scores in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003einteraction\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003einteraction\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003etime\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003etime\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003etreatment\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003etreatment\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHAMD\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e26.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e78.318/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e67.932/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e59.593/0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e25.88\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e23.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e16.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHAMA\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e25.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e67.312/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e55.482/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e71.479/0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e24.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e22.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e20.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e23.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eHAMD: Hamilton Depression Scale, HAMA: Hamilton Anxiety Scale; a: statistically significant difference between the three groups; b: no statistically significant difference between the three groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA statistically significant PSQI score difference was observed between the three groups after treatment (3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 VS 6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54 VS 9.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 points, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;43.142, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Further two-by-two comparisons showed that the order for the magnitude of PSQI scores after treatment was: control group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.2 mg group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.3 mg group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of PSQI scores in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePSQI\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e18.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e9.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003ePSQI: Pittsburgh Sleep Quality Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003eAnalysis of CD-RISC, SNOT-20, and VAS scores\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFor the effect of different treatments on patients\u0026rsquo; CD-RISC, SNOT-20, and VAS scores within 9 days, the data in each group obeyed an approximately normal distribution (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and an equal variance-covariance matrix between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, data expressed as x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the interactions of CD-RISC, SNOT-20, and VAS score time*treatment were significant in all three groups (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eCD\u0026minus;RISC score interaction\u003c/em\u003e\u003c/sub\u003e=56.149, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eSNOT\u0026minus;20 score interaction\u003c/em\u003e\u003c/sub\u003e=98.418, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eVASscore interaction\u003c/em\u003e\u003c/sub\u003e=89.492, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating different individual effect sizes in the three categories of postoperative scores at the four-time points in patients treated with different esketamine concentrations. All four categories of scores decreased over time in all three groups (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eCD\u0026minus;RISCscore time\u003c/em\u003e\u003c/sub\u003e=76.298, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eSNOT\u0026minus;20score time\u003c/em\u003e\u003c/sub\u003e=68.482, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eVASscore time\u003c/em\u003e\u003c/sub\u003e=71.483, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating the distinct changes in magnitude of these three categories of scores over time. Moreover, different concentrations of esketamine s had different effects on the CD-RISC, SNOT-20, and VAS scores (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eCD\u0026minus;RISCscore treatment\u003c/em\u003e\u003c/sub\u003e=65.549, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eSNOT\u0026minus;20score treatment\u003c/em\u003e\u003c/sub\u003e=66.429, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eVASscore treatment\u003c/em\u003e\u003c/sub\u003e=56.73, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A two-by-two scores comparison on days 1, 3, 5, and 9 revealed that all three groups had the same order for magnitude of the SNOT-20 and VAS scores at the four-time points: the control group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.2 mg group\u0026thinsp;\u0026gt;\u0026thinsp;the 0.3 mg group; and the CD-RISC scores were in the same order for magnitude at the four-time points: the control group\u0026thinsp;\u0026lt;\u0026thinsp;the 0.2 mg group\u0026thinsp;\u0026lt;\u0026thinsp;the 0.3 mg group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of CD-RISC, SNOT-20, and VAS scores in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2 mg group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003einteraction\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003einteraction\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003etime\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003etime\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003etreatment\u003c/em\u003e\u003c/sub\u003e/\u003cem\u003eP\u003c/em\u003e \u003csub\u003e\u003cem\u003etreatment\u003c/em\u003e\u003c/sub\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCD-RISC\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e40.45\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e41.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e56.149/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e76.298/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e65.549/0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e48.47\u0026thinsp;\u0026plusmn;\u0026thinsp;11.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e45.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.46\u0026thinsp;\u0026plusmn;\u0026thinsp;9.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e53.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e50.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e76.49\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e65.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e55.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e85.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e76.45\u0026thinsp;\u0026plusmn;\u0026thinsp;13.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e59.75\u0026thinsp;\u0026plusmn;\u0026thinsp;13.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSNOT-20\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.15\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e23.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e98.418/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e68.482/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e66.429/0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e20.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e21.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.12\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e18.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003cp\u003e(points, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e7.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e89.492/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e71.483/0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e56.73/0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e7.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9d\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eCD-RISC: Connor-Davidson Resilience Scale; SNOT-20: Sino-nasal Outcome Test-20; VAS: Visual Analogue Scale; a: statistically significant difference between the three groups, b: no statistically significant difference between the three groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePain, a painful response and an unpleasant emotional sensation that the organism experiences in response to injurious stimuli is the fifth vital sign after temperature, pulse, respiration, and blood pressure \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Postoperative pain, as an acute pain occurring rapidly after surgical injury to tissues, has a close bearing on the magnitude of surgical trauma, and the degree of inflammatory response especially excessive stress can be detrimental to the organism to a certain extent. Additionally, it may cause internal environmental and metabolic disorders in the organism and lead to gastrointestinal dysfunction, which seriously affects patients, especially in some elderly and frail patients, sleep, diet, and organ dysfunction \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Postoperative pain, anxiety, and tension easily lead to fluctuations in hormone levels \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, which is not conducive to a good recovery after surgery, and it also is the primary reason for patients' delayed discharge from the hospital.\u003c/p\u003e \u003cp\u003ePatients with endoscopic sinus surgery experience a period of pain in which local anesthetic infiltration or local packing does not adequately relieve postoperative pain, and other analgesic drugs are yet to be used \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Esketamine, an isomer of ketamine, produces analgesic, sedative, and amnestic, plays mainly its role in anti-inflammatory and antidepressant by blocking N-methyl-D-aspartate (NMDA) receptors \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for clinical relief of osteoarthritis, rheumatoid arthritis, and various pain symptoms but some adverse reactions also accompany, such as gastric mucosal lesions, gastric bleeding, and liver and kidney function. Esketamine and NSAIDs are not identical in their mechanism of action and target point. Their combined application can synergistically increase a patient\u0026rsquo;s pain threshold, and reduce pain sensation and inflammatory response, which effectively reduces some clinical symptoms such as nociceptive hypersensitivity with favorable efficacy.\u003c/p\u003e \u003cp\u003eThe SNOT-20 and VAS, as chronic sinusitis-specific QOL measurement scales, have been extensively applied worldwide, with the advantages of \u0026ldquo;depth and sensitivity\u0026rdquo;. The 20 symptoms of SNOT-20 have a close bearing on chronic sinusitis \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The scale is highly targeted for sinus-related disorders, focusing on nose-related symptoms and covering physical problems, social functioning, and emotional outcomes. Its items are simple and easily understood, with a greater practicality. The VAS scale is able to intuitively reflect patients' severity of their disease \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. In this study, the SNOT-20 and VAS scores of those who used esketamine were lower than those who did not, which is consistent with previous literature reports to the efficacy of esketamine in effective pain relief and life quality improvement \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDepression is caused by clustered discharges in the \u0026ldquo;anti-reward center\u0026rdquo; of the lateral rein nucleus, which strengthens the inhibitory effect of the lateral rein nucleus on the \u0026ldquo;reward center\u0026rdquo; of the monoamine nucleus in the midbrain. Esketamine achieves antidepression by blocking the clustered firing of these reinnucleus neurons and eliminating their inhibitory effect on the reward center \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e; it has a high affinity for the N-methyl-D-aspartate receptor where the main mechanism involves the sustained selective blockade of the subtypes of NMDA receptor, leading to dephosphorylation of eEF2 and increased expression of trotomyosin receptor kinase B (TrkB). In this way, esketamine ultimately acts by increasing the release of neurotrophic factors to improve neuroplasticity and synapse formation \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Perioperative anxiety is mostly caused by the disease itself, surgical anesthesia, and other factors. It is accompanied by hemodynamic abnormalities involving the sympathetic and parasympathetic nervous systems, and the endocrine system, and it can be manifested as restlessness, fatigue, inattention, and muscle tension \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. The mechanism of esketamine on antianxiety possibly includes its superior affinity for NMDA receptors and opioid receptors, which may synergize sedation and further reduce the pain and inflammatory state in the perioperative period \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Patients who used esketamine had lower HAMA and HAMD scores than those who did not, which suggests that esketamine is effective in relieving anxiety and depression in patients.\u003c/p\u003e \u003cp\u003eFollowing FESS, the abundant nerve endings in the nasal cavity, will be compressed by the tamponade, then to irritate the mucosal tissues of the nasal cavity and sinuses, and cause pain and discomfort in the nasal and frontal regions, dyspnea, and hypoxia. Patients suffering from such diseases are prone to difficulty falling asleep and waking up easily from sleep suffocation, irritability, and anxiety \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. It has been reported that those sleep problems in patients with FESS severely affect their sleep quality and recovery after surgery \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Chronic poor sleep also causes psychological resilience and poor psychological maturity \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. We showed that the CD-RISC and PSQI scores of those who used esketamine were higher than those who did not, indicating the efficacy of esketamine in effective relief to anxiety and depression.\u003c/p\u003e \u003cp\u003eNevertheless, there are limitations to this study. First, the small size of the samples limited our findings, which should be further expanded in the future. Second, no long-term follow-up was conducted and the related effect of intervention should also be judged in follow-up. Finally, multiple variable factors were found to influence the efficacy of nasal endoscopic surgery in combination, which is possibly due to individualized differences. Nevertheless, the relationship between these suspected influencing factors and the efficacy of nasal endoscopic surgery should provide guidance for clinical treatment in chronic sinusitis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSmall doses of esketamine reduce postoperative anxiety and depression in patients with sinus surgery, relieve symptoms, and improve the quality of sleep.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot required ethics approval, patient identifiers, and patient consent for publication because the study data included in this study were de-identified. All methods in this study were carried out in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in this analysis are available from.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Guangzhou Municipal Science and Technology Project (2023A03J0508 and 2024A03J00721). The funders had no role in the study design, data collection or analysis, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYPZ and ZF contributed to the conception and design of the study. YPZ, JCL , CL, and XSF organized the database, performed the statistical analysis, and drafted the initial manuscript. ZF critically revised the manuscript and provided project administration. All authors gave final approval for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShi Yafang. Clinical efficacy of functional endoscopic sinus surgery for chronic sinusitis and its impact on patients\u0026rsquo; quality of life[J]. J Med Forum. 2017;38(7):117\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRula S. Song Lihua. Research on the clinical treatment of chronic sinusitis[J]. 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Psychological resilience mediates the association between sleep quality and anxiety symptoms: A repeated measures study in college students. PLoS ONE. 2023;18(10):e0292887. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0292887\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0292887\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"esketamine, sinus surgery, sleep quality, pain","lastPublishedDoi":"10.21203/rs.3.rs-3982476/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3982476/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the benefits of low-dose esketamine on pain relief and sleep quality improvement after sinus surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOne hundred and thirty-five patients admitted to our hospital between June 2018 and September 2023 who suffered from sinusitis and were scheduled to undergo functional endoscopic sinus surgery were recruited. Three groups were divided as 0.2 mg (n\u0026thinsp;=\u0026thinsp;45), 0.3 mg (n\u0026thinsp;=\u0026thinsp;45), and control (n\u0026thinsp;=\u0026thinsp;45) using a random number table. Three groups were tested for the Pittsburgh Sleep Quality Index (PSQI), the Visual Analogue Scale (VAS), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the Connor-Davidson Resilience Scale (CD-RISC), and the Sino-nasal Outcome Test-20 (SNOT-20), and the related scores were analyzed by comparing their means between the groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEsketamine affected differently the PSQI, the VAS, the HAMD, the HAMA, the CD-RISC, and the SNOT-20 scores in patients (\u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003ePSQI score treatment\u003c/em\u003e\u003c/sub\u003e=67.569 \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMD score treatment\u003c/em\u003e\u003c/sub\u003e=59.593, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eHAMA score treatment\u003c/em\u003e\u003c/sub\u003e=71.479, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eCD\u0026minus;RISC score treatment\u003c/em\u003e\u003c/sub\u003e=65.549, \u003cem\u003eF\u003c/em\u003e \u003csub\u003e\u003cem\u003eSNOT\u0026minus;20 score treatment\u003c/em\u003e\u003c/sub\u003e=66.429, \u003cem\u003eF\u003c/em\u003e\u003csub\u003e\u003cem\u003eVAS score treatment\u003c/em\u003e\u003c/sub\u003e=56.73, all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The PSQI, the HAMD, the HAMA, the SNOT-20, and the VAS scores were in the same order at the four-time points of 1, 3, 5, and 9 days ( the order at all four-time points was: control\u0026thinsp;\u0026gt;\u0026thinsp;0.2 mg\u0026thinsp;\u0026gt;\u0026thinsp;0.3 mg), while the order of the CD-RISC scores at the four-time points was: control\u0026thinsp;\u0026lt;\u0026thinsp;0.2 mg\u0026thinsp;\u0026lt;\u0026thinsp;0.3 mg.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLow-dose esketamine boasts relief of postoperative anxiety, pain, and depression, reduction of patient symptoms, and improvement of sleep quality after sinus surgery.\u003c/p\u003e","manuscriptTitle":"Improvement and clinical benefit analysis of low-dose ketamine on postoperative pain and sleep after sinus surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-06 19:21:49","doi":"10.21203/rs.3.rs-3982476/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a088ba1d-9da8-47d3-b99c-e2385e7ad25b","owner":[],"postedDate":"March 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-04T18:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-06 19:21:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3982476","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3982476","identity":"rs-3982476","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}