Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Abstract

Background: The aim of this randomized double-blind placebo controlled clinical trial was to investigate the effects of different doses of esketamine combined with sufentanil for postoperative intravenous controlled analgesia after cesarean section and the incidence of postpartum depression. Methods: One hundred and sixty patients undergoing elective cesarean section, with a singleton term pregnancy and American Society of Anesthesiologists physical status II were selected. All patients were treated by a combined epidural with spinal anesthesia. They were randomly divided into 4 groups according to patient controlled intravenous analgesia formula. The consumption of sufentanil, times of effective press and remediate analgesia at 48 hours after cesarean section, incidence of postpartum depression (PPD) at 1 week and 6 weeks after the operation were recorded. Results: Comparison of cumulated dosage of sufentanil, times of effective press and rescue analgesia at 48 hours after operation: Group H was significantly lower than Group M, Group L, and Group C (P < .05), Group M significantly lower than group L and Group C (P < .05), and Group L significantly lower than Group C (P < .05). Comparison of the incidence of PPD at 1 week and 6 weeks later: Group H was significantly lower than Group M, Group L, and Group C (P < .01), Group M significantly lower than Group L and Group C (P < .01) and Group L significantly lower than Group C (P < .01). Compared with Group C, the incidence of nausea and vomiting was significantly reduced in Group H, Group M, and Group L (P < .05). Conclusion: Esketamine combined with sufentanil used for patient controlled intravenous analgesia after elective cesarean section can reduce the consumption of sufentanil, improve postoperative analgesia, decrease the incidence of PPD at 1 week and 6 weeks and postoperative nausea and vomiting.

Effect of esketamine on postoperative depressive symptoms in patients undergoing thoracoscopic lung cancer surgery: A randomized controlled trial

“…Another recent study showed that esketamine alleviated short-term depressive symptoms after laparoscopic modified radical hysterectomy ( 19 ). Furthermore, several studies also suggested that the use of esketamine prevented postpartum depressive symptoms after cesarean section ( 31 , 32 ). A recent study showed that intraoperative esketamine infusion improved postoperative sleep disturbance, but not depression symptoms, after gynecological laparoscopy ( 12 ).…”

Effect of low-dose esketamine combined with labour analgesia on postpartum depression in spontaneous labour: a prospective case-control study

“…Previous studies have shown that esketamine is fast and effective in reducing the onset of postnatal depression with a low incidence of adverse events. Wang et al [19] . observed that esketamine combined with sufentanil improved postoperative analgesia in patients after elective caesarean section and reduced the dosage of sufentanil and the incidence of PPD and postoperative nausea and vomiting at 1 and 6 weeks postoperatively.…”

Routine Prophylactic Esketamine for the Prevention of Maternal Pain During Cesarean Delivery

“…Studies investigating the use of esketamine are even scarcer, with only 4 RCTs (n = 56-210) examining the role of systemic esketamine for cesarean pain but with substantially different study designs, primary outcomes, and esketamine doses. [4][5][6][7] Overall, the studies are, however, promising, suggesting that esketamine is associated with reduced intraoperative pain, reduced postoperative pain, and the need for lower doses of local anesthetic for spinal anesthesia. Two of the studies 6,7 also considered postnatal depression given the increasing recognition of esketamine as an effective treatment for depression, but the effects here were nonconsistent, potentially reflecting the short period of use.…”

“…A meta-analysis of 20 RCTs (1737 patients) assessing the more commonly used racemic ketamine during cesarean delivery reported decreased postoperative pain and analgesia use, although the effect on intraoperative pain was not reported. Studies investigating the use of esketamine are even scarcer, with only 4 RCTs (n = 56-210) examining the role of systemic esketamine for cesarean pain but with substantially different study designs, primary outcomes, and esketamine doses . Overall, the studies are, however, promising, suggesting that esketamine is associated with reduced intraoperative pain, reduced postoperative pain, and the need for lower doses of local anesthetic for spinal anesthesia.…”

“…Overall, the studies are, however, promising, suggesting that esketamine is associated with reduced intraoperative pain, reduced postoperative pain, and the need for lower doses of local anesthetic for spinal anesthesia. Two of the studies also considered postnatal depression given the increasing recognition of esketamine as an effective treatment for depression, but the effects here were nonconsistent, potentially reflecting the short period of use. Only 1 study assessed intraoperative pain and neonatal outcomes, reporting that esketamine was associated with reduced rates of visceral traction discomfort in the esketamine group (7.5% vs 45%, P < .001), without an increase in adverse neonatal effects.…”