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This systematic review and meta-analysis evaluated whether perioperative esketamine prevents PONV and supports gastrointestinal recovery. Searches of Embase, PubMed, Web of Science, and the Cochrane Library (inception to August 2025) included randomized controlled trials. Thirty-eight trials (3,425 patients) showed reduced nausea and vomiting, faster time to first flatus, and lower rescue analgesic needs within 2 days, while also increasing anesthesia recovery time and prolonging PACU stay.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/efficacy-of-esketamine-in-reducing-nausea-and-vomiting-after-anesthesia-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials/449444/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/efficacy-of-esketamine-in-reducing-nausea-and-vomiting-after-anesthesia-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials/449444.png","ImageObject",300,407,{"name":92,"@type":93},"Danger Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the primary outcome of the study?","Question",{"text":112,"@type":113},"The primary outcome was PONV incidence. 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This study evaluated the efficacy of perioperative esketamine in preventing PONV.  \nMaterials and methods: We systematically searched Embase, PubMed, Web of Science, and the Cochrane Library from inception to August 2025 for randomized controlled trials investigating the effect of perioperative esketamine on PONV. The primary outcome was PONV incidence. Secondary outcomes included time to first flatus, postoperative pain degree, anxiety scores, agitation, anesthesia recovery time, and post-anesthesia care unit (PACU) stay duration. Data were analyzed using RevMan 5.4 and STATA 15.0 software. Sensitivity and subgroup analyses were performed to assess result stability and explore potential sources of heterogeneity.  \nResults: Thirty-eight randomized trials (3,425 patients) were included. Esketamine reduced the risk of nausea (RR=0.69, 95% CI: 0.53–0.90) and vomiting (RR=0.75, 95% CI: 0.57–0.98), shortened time to first flatus (SMD=–0.81, 95% CI: −1.48 to –0. 15), and decreased rescue analgesic needs within 2 days (SMD=0.32, 95% CI: 0.2–0.5). However, it prolonged anesthesia recovery time (SMD=0.97, 95% CI: 0.28–1.67) and PACU stay (SMD=0.76, 95% CI: 0.27–1.26).  \nConclusions: Perioperative esketamine may reduce PONV and aid gastrointestinal recovery, but its potential to delay anesthesia recovery and PACU discharge requires consideration. Further studies are needed to clarify its risk-benefit profile.  \nDate of first submission to PROSPERO: 10 March 2024  \nDate of the start of study screening against eligibility criteria: 21 March 2024  \nIntroduction  \nARTICLE HISTORY  \nReceived 16 April 2025 Accepted 9 December 2025  \nKEYWORDS  \nAnesthesia; esketamine; gastrointestinal dysfunction; nausea and vomit  \nPostoperative nausea and vomiting (PONV) is a common complication following general anesthesia and surgery, and is closely associated with prolonged hospital stays, increased healthcare costs, and reduced patient satisfaction[1,2] . Despite various preventive measures, the reported incidence of PONV remains high, ranging from 20% to 60% . According to the Apfel risk scoring system, female sex, non-smoking status, history of motion sickness or PONV, and postoperative opioid use are key risk factors [3–5]; patients with three or four of these factors are considered high risk for PONV.  \nThe type of surgery itself is an important determinant of PONV risk. Generally, longer surgical duration and greater tissue trauma correlate with a higher risk of PONV. For instance, abdominal surgeries (particularly laparoscopic procedures) significantly increase PONV risk due to direct manipulation and traction of the gastrointestinal tract, which can readily induces gastrointestinal dysfunction. Gynecological  \nCONTACT shuangquan Qu  [shuangquanqu@126.com](shuangquanqu@126.com)  Hunan children’s Hospital, 86 Ziyuan Road, Yuhua district, changsha city, Hunan Province, china.  \n supplemental data for this article can be accessed online at [https://doi.org/10.1080/07853890.2025.2604409](https://doi.org/10.1080/07853890.2025.2604409) .  \n© 2025 The Author(s) . Published by informa UK limited, trading as Taylor & francis Group  \nThis is an open Access article distributed under the terms of the creative commons Attribution-noncommercial license ([http://creativecommons.org/licenses/](http://creativecommons.org","cbCaib4qW3mRx7Sv","https://ap.wps.com/l/cbCaib4qW3mRx7Sv","pdf",1404614,"English","# Abstract\n## Background\n## Materials and methods\n## Results\n## Conclusions\n# Introduction\n## PONV risk factors and surgical determinants\n## Gastrointestinal recovery and opioid-related mechanisms\n## Role of esketamine in anesthesia","[{\"question\":\"What was the primary outcome of the study?\",\"answer\":\"The primary outcome was PONV incidence. Secondary outcomes included time to first flatus, postoperative pain degree, anxiety scores, agitation, anesthesia recovery time, and PACU stay duration.\"},{\"question\":\"How many randomized controlled trials and patients were included?\",\"answer\":\"Thirty-eight randomized trials including 3,425 patients were included in the meta-analysis.\"},{\"question\":\"What benefits and drawbacks did perioperative esketamine show for PONV?\",\"answer\":\"Esketamine reduced nausea and vomiting and improved gastrointestinal recovery measures, but it prolonged anesthesia recovery time and increased PACU stay duration.\"}]","Efficacy of esketamine in reducing nausea and vomiting after anesthesia - a systematic review and meta-analysis of randomized controlled trials | PDF",1790730230]