Abstract: Objective The purpose of this study was to observe improvement of enhanced recovery after laparoscopic cholecystectomy (LC) by intraoperative infusion of esketamine in patients with gallstones. Methods A total of 98 patients with gallstones were encountered in our hospital between October 2024 and October 2025, randomly divided into two groups, and all underwent LC. At anesthesia maintaining stage, normal saline was given in control group, and intraoperative intravenous infusion of esketamine was given until discontinuation of surgery. Visual analog scale (VAS) was used to assess pain degree, and 15-item quality of recovery (QoR-15) scale was applied to evaluate recovery quality. Serum interleukin-6 (IL-6) , IL-8 and tumor necrosis factor-alpha (TNF-α) levels were measured by ELISA. Results By one hour and twelve hours after operation, resting VAS scores in the observation group were(2.6±0.3) and (2.7±0.4), both much lower than [(3.3±0.5) and (3.4±0.3), respectively, P<0.05],and motion VAS scores were (2.9±0.3) and (2.8±0.2), both much lower than [(3.6±0.4) and (3.5±0.4), respectively, P<0.05] in the control group; by twelve and twenty-fours, QoR-15 scores in the observation were (114.3±10.2) and (120.0±11.3), both significantly greater than [(101.6±7.1) and (109.4±8.8), respectively, P<0.05] in the control; by end of twenty-four after surgery, serum IL-6, IL-8 and TNF-α levels in the observation were (82.3±9.7)pg/L, (51.3±9.0)pg/L and (16.5±1.9)pg/L, all much lower than [(105.8±10.5)pg/L, (83.7±11.3)pg/L and (22.8±2.3)pg/L,respectively, P<0.05] in the control group. Conclusion Boosting intravenous infusion of esketamine once before discontinuation of LC could improve enhanced recovery after surgery (ERAS) in patients with gallstones, and warrants further clinical investigation.

Key words: Gallstone, Laparoscopic cholecystectomy, Esketamine, Anesthesia, Enhanced recovery after surgery