Intraoperative Low-Dose S-Ketamine Reduces Depressive Symptoms in Patients with Crohn's Disease Undergoing Bowel Resection: A Randomized Controlled Trial

Background: Patients with Crohn's disease (CD) undergoing bowel resection frequently experience depression and acute postoperative pain. This randomized, double-blind trial investigated whether intraoperative S-ketamine preconditioning reduces postoperative depressive symptoms in CD patients with mild-to-moderate depression and assessed effects on pain and inflammation. Methods: 124 adults were randomized to S-ketamine or placebo. The S-ketamine group received 0.25 mg/kg IV during anesthesia induction, followed by 0.12 mg/kg/h infusion for >30 min; placebo received volume-matched saline. Primary outcome: 17-item Hamilton Depression Scale (HAMD-17). Secondary outcomes: Patient Health Questionnaire-9 (PHQ-9), Quality of Recovery (QoR-15), Numeric Rating Scale (NRS) for pain, C-reactive protein (CRP), interleukin-6 (IL-6) on POD 1, 3, 5, length of stay, and opioid use. Results: S-ketamine reduced PHQ-9 and HAMD-17 scores vs placebo on POD 1, 2, and 7; QoR-15 was higher on POD 3 and 5; NRS pain scores were lower in PACU, POD 1 and 2. CRP and IL-6 did not differ between groups, nor did postoperative complications or length of stay. Opioid consumption within 2 days post-op was lower with S-ketamine. Conclusions: Intraoperative low-dose S-ketamine alleviated mild-to-moderate depressive symptoms and early postoperative pain in CD patients undergoing bowel resection without compromising safety.