To investigate the effect of esketamine combined with thoracoscopic-guided thoracic paravertebral block (TTPB) on the quality of recovery and analgesic consumption after lobectomy for lung cancer.

Seventy-two patients with lung cancer who underwent thoracoscopic lobectomy in our hospital from January 2022 to September 2025 were selected. According to the perioperative analgesia regimen, they were divided into an observation group 35 cases and a control group 37 cases. The observation group received continuous intravenous infusion of esketamine combined with thoracoscopic-guided thoracic paravertebral block, while the control group received an equal volume of normal saline combined with thoracoscopic-guided thoracic paravertebral block. The quality of recovery-15 (QoR-15) scores, visual analogue scale (VAS) scores at rest and during activity at different time points after surgery, extubation time, time to first ambulation, length of hospital stay, number of patient-controlled intravenous analgesia (PCIA) bolus attempts within 48 h after surgery, rescue analgesic consumption, and incidence of adverse reactions were compared between the two groups.

At 24 h and 48 h after surgery, the QoR-15 scores in the observation group were higher than those in the control group [(82.36±5.78) vs. (73.12±6.05), (91.45±4.32) vs. (82.67±5.11); t=7.241, 8.604; P<0.001]. At 6, 12, 24, and 48 h after surgery, the resting VAS scores in the observation group were lower than those in the control group [(3.12±0.89) vs. (4.56±0.98), (2.78±0.76) vs. (3.98±0.87), (2.41±0.65) vs. (3.23±0.78), (1.64±0.54) vs. (2.21±0.67); t=7.133, 6.812, 5.296, 4.344; P<0.001]. The VAS scores during activity in the observation group were also lower than those in the control group [(4.23±1.01) vs. (5.89±1.12), (3.78±0.92) vs. (5.12±1.03), (3.32±0.85) vs. (4.34±0.98), (2.51±0.76) vs. (3.12±0.89); t=7.218, 6.363, 5.156, 3.418; P<0.001]. The extubation time [(18.76±4.32) min vs. (25.45±5.11) min; t=6.556, P<0.001], time to first ambulation [(22.34±5.67) min vs. (30.12±6.05) min; t=6.153, P<0.001], and length of hospital stay [(6.89±1.23) d vs. (8.76±1.54) d; t=6.222, P<0.001] in the observation group were shorter than those in the control group. The total number of PCIA bolus attempts at 24 h [(4.32±1.23) vs. (8.98±1.98); t=13.110, P<0.001], the total number at 48 h [(7.89±1.87) vs. (15.67±2.76); t=15.303, P<0.001], the number of effective bolus deliveries [(3.78±1.01) vs. (8.98±1.56); t=18.348, P<0.001], and rescue analgesic consumption [(25.67±8.98) mg vs. (58.98±12.34) mg; t=14.312, P<0.001] were all lower in the observation group than in the control group. The incidence of adverse reactions was 9.30% in the observation group and 13.33% in the control group (P>0.05).

Esketamine combined with thoracoscopic-guided thoracic paravertebral block can improve the quality of recovery after thoracoscopic lobectomy for lung cancer, enhance analgesic efficacy, reduce postoperative opioid analgesic consumption, and accelerate recovery, with a good safety profile and no increase in the incidence of adverse reactions.