The effect of low-dose esketamine on pain and post-partum depression after cesarean section: A prospective, randomized, double-blind clinical trial

Abstract

ObjectiveTo observe and evaluate the effect of a single intravenous injection of low-dose esketamine on post-operative pain and post-partum depression (PPD) in cesarean delivery patients.MethodsA total of 210 patients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were divided into an esketamine group (Group S, n = 105) and a normal saline group (Group L, n = 105) by a random number table. At 5 min after childbirth, patients in the S group were given 0.25 mg/kg esketamine, whereas patients in the L group received an equal volume of saline. The primary outcomes included post-operative pain control according to the Numerical Rating Scale (NRS) and the incidence of PPD according to the Edinburgh Post-partum Depression Scale (EPDS). The secondary outcomes included analgesia-related adverse events and Ramsay sedation scores.ResultsThis clinical study was a prospective, randomized, double-blind trial. A total of 210 patients were enrolled in this study. The NRS pain (cough pain) score was lower in the S group than in the L group at 24 h after surgery (P = 0.016), and there was no significant difference in resting pain and mobilization pain at 4, 8, and 48 h after surgery or resting pain at 24 h after surgery between the two groups. There was no significant difference in the prevalence of PPD between the two groups on the day before delivery, or at the first week, the second week, or the fourth week after childbirth. At 5 min after dosing, the incidence of hallucinations (P < 0.001) and dizziness (P < 0.001) was higher in the S group than in the L group. At 15 min after dosing, the incidence of dizziness (P < 0.001) and nausea (P = 0.011) was higher in the S group than in the L group. The incidence of dizziness (P < 0.001) was higher in the S group than in the L group when leaving the operating room. The Ramsay scores in Group S were lower than in Group L at 5 min (p < 0.001), 15 min (p < 0.001) after dosing and at the time of leaving the operating room (p < 0.001).ConclusionIn this study, a single intravenous injection of 0.25 mg/kg esketamine did not reduce the incidence of depression at 1, 2, or 4 w post-partum but improved pain during exercise at 24 h post-operatively under the conditions of this clinical trial.Clinical trial registration[www.chictr.org.cn], identifier [ChiCTR2100054332].

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

“…It may also be due to the lower pain intensity in both groups as a result of multimodal analgesia. Our results are supported by the study by Shen et al [22] . In this study, a single intravenous dose of 0.25 mg/kg of esketamine did not reduce the incidence of depression at 1, 2 or 4 weeks postpartum, but improved pain during exercise 24 hours postoperatively under this condition.…”

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

“…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. Consistent with the critical adverse outcomes reported by Xu et al, 3 of the 4 studies noted increased psychoactive effects in the esketamine groups.…”

“…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.…”