Objective To investigate the effect of subanesthetic dose of esketamine on emergence agitation （EA） in patients undergoing laparoscopic hernia repair. Methods Seventy?two male patients who treated with laparoscopic hernia repair under general anesthesia were randomly divided into AS group （subanesthetic esketamine） and control group. In the AS group， 0.2 mg/kg of esketamine was administered intravenously 30 minutes before the surgery ended， while the control group was given an equal volume of normal saline. Upon surgery completion， patients were transferred to PACU with endotracheal tube retained， and the time to extubation was recorded. Hemodynamic parameters were measured immediately after extubation and at 10 min， 30 min， 1 h， and 4 h thereafter. Patients′ pain and sedation levels were assessed at the above time points using RASS and VAS， respectively. The incidence of EA was evaluated using the Confusion Assessment Method for the Intensive Care Unit （CAM?ICU）. Observation duration in the PACU and recovery outcomes within 24 hours postoperatively were assessed via the QoR?40 and adverse events were recorded. Results Compared to those in the control group， patients in the AS group had higher HR and MAP at 10 min post?extubation， and the changes in HR and MAP over time were more stable（P < 0.05）. The RASS and VAS scores in the AS group were significantly lower than those in the control group at the time of extubation and all subsequent time points（P < 0.05）， both groups showed temporal changes in RASS and VAS scores （P < 0.05）， but the change process in the AS group was more stable（P < 0.05）. Postoperative extubation time， PACU observation duration， and adverse event rates （delirium， respiratory depression， nausea and vomiting） did not differ significantly between the two groups （P > 0.05）， while recovery quality was markedly better in the AS group （P < 0.05）. Conclusion Subanesthetic esketamine effectively alleviates pain and the incidence of EA， supports hemodynamic stability during PACU stay， and enhances recovery quality in patients undergoing laparoscopic hernia repair， demonstrating clinical value.