Effect of ultrasound-guided interscalene brachial plexus block using liposome bupivacaine combined with continuous esketamine infusion on quality of recovery in patients undergoing arthroscopic rotator cuff repair: study protocol for a randomized controlled trial

BACKGROUND: Arthroscopic rotator cuff repair is the standard of care for rotator cuff tears. However, postoperative pain and recovery remain a significant clinical challenge. While ultrasound-guided interscalene brachial plexus block with liposomal bupivacaine provides sustained analgesia for up to 72 h, the addition of esketamine intravenous infusion may offer further benefits through enhanced pain control, mood stabilization, and cognitive support. This study aims to evaluate the synergistic effect of this combination on the quality of postoperative recovery in patients undergoing arthroscopic rotator cuff repair. METHODS: This single center, randomized controlled trial will enroll 278 patients undergoing arthroscopic rotator cuff repair. Participants will be randomly allocated at a 1:1 ratio to either the intervention or control group. The intervention group will receive a combination of an ultrasound-guided interscalene brachial plexus block with liposomal bupivacaine and a continuous intravenous esketamine infusion, while the control group will receive a saline infusion. The primary outcome is the 15-item Quality of Recovery (QoR-15) score at 24 h postoperatively. Secondary outcomes include QoR-15 scores at various time points within 30 days, pain scores, total opioid consumption, need for rescue analgesia, incidence of postoperative delirium, hospital anxiety and depression scale scores, sleep quality, length of hospital stay, and adverse events. DISCUSSION: Guided by Enhanced Recovery After Surgery principles, this randomized controlled trial investigates a novel combination of liposomal bupivacaine block and esketamine infusion to enhance postoperative recovery after arthroscopic rotator cuff repair. It specifically assesses patient-reported recovery through the QoR-15 score, a validated tool encompassing pain, physical comfort, independence, and psychological well-being. As a single-center initiative, this work represents a pivotal step in generating preliminary evidence for this multimodal strategy. TRIAL REGISTRATION: This study has been approved by the Ethics Committee at West China Hospital, Sichuan University (approval no. 2025-1908). The trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500112854) on November 20, 2025.