Effect of low-dose esketamine on pain control and postpartum depression after cesarean section: a retrospective cohort study

Abstract

Background: Esketamine is used to control postoperative pain and reduce postoperative depression in surgical patients. This study was performed to determine the effects of esketamine on pain control as well as postpartum depression (PPD) in pregnant women who underwent cesarean section (CS).Methods: Pregnant women who underwent CS between March 2018 and February 2020 at our hospital were retrospectively reviewed. Parturients in the control group received 50 µg sufentanil citrate and 0.25 mg palonosetron hydrochloride, while those in the experimental group received additional 0.2-0.5 mg/kg esketamine. The primary outcomes included postoperative pain control according to the numeric rating scale (NRS) and the incidence of PPD according to the Edinburgh postnatal depression scale (EPDS).Multivariable linear regression analysis was performed to determine the relationship between the use of esketamine, pain control, and the incidence of PPD after CS.Results: There were 132 parturients in the control group and 108 parturients in the esketamine group in this study. All NRS scores at rest at any time point were much lower in the esketamine group than those in the control group. Besides, NRS scores when coughing were also lower in the esketamine group within 24 hours. EPDS scores were lower in the esketamine group than those in the control group within 3 months postpartum. Esketamine acted as a protector of pain control and was confirmed to improve the incidence of PPD using multivariable linear regression. Parturients had dramatically better sleep quality within 1 week postpartum (P=0.044), and morphine consumption within 24 hours postpartum was lower in the esketamine group than in the control group (P<0.001). The quality of recovery within 3 months postpartum was also better in the esketamine group (P=0.001). A subgroup analysis of 2 subgroups divided according to the dose of esketamine was then performed, indicating no significant difference between the low-dose group and high-dose group in most included outcomes.Conclusions: This study confirmed the effects of esketamine on pain control and the incidence of PPD in pregnant women who underwent CS. Considering the potential adverse events, low-dose esketamine may be more suitable for pregnant women who have undergone CS.

Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review

“…The 29 published studies included 3,500 patients assigned to various ketamine regimens including racemic ketamine, esketamine, or treatment as usual. Overall, the sample sizes of the clinical trials and observational studies ranged from N = 16 to N = 654 (mean N = 205, SD = 167): specifically, ten studies had sample sizes over 100 ( 39 , 41 – 43 , 45 , 47 , 49 , 50 , 54 , 55 ), three studies had sample sizes between 50 and 100 ( 46 , 48 , 52 ), and the remaining four studies had sample sizes of less than 50 people ( 40 , 44 , 51 , 53 ). The clinical trials and observational studies that examined CDCP had varying sample sizes, with the smallest having N = 16 and the largest having N = 417 participants.…”

“…All clinical trials with patients undergoing surgery and experiencing acute pain applied a single injection of ketamine ranging from 0.20 mg/kg to 1.0 mg/kg, one of which also administered 160 mg post-operation via patient-controlled intravenous analgesia ( 43 ). One observational study ( 55 ) applied esketamine doses ranging from 0.2 mg/kg to 0.5 mg/kg intravenously. Only one case study ( 62 ) administered a ketamine infusion of 19 mg/kg over 4 days in an acute pain setting.…”

“…At the full-text level, 599 studies (576 published articles and 23 registered trials) did not meet the inclusion criteria. This resulted in the final number of 29 published studies included in the present review (14 clinical trials (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52), 3 observational studies (53)(54)(55), and 12 case studies (56-67)), as well as 5 registered (i.e., ongoing and planned) clinical trials (68)(69)(70)(71)(72). Figure 1 illustrates the PRISMA (36) flow chart for this systematic review.…”

“…The most common scales used to assess depression symptoms across published studies were the Hamilton Depression Rating Scale (HDRS) (N = 6) (40,42,45,46,52,65) and Hospital Anxiety and Depression Scales (HADS) (N = 6) (39,40,44,51,54,67). The Edinburgh Postnatal Depression Scale (EPDS) (N = 5) (43,47,49,50,55) and Montgomery-Åsberg Depression Rating Scale (MADRS) were also frequently used (N = 4) (48,51,56,67). The Visual Analogue Scale (VAS) was the most No differences between the groups on HDRS 17 scores at 3 weeks postintervention (p = 0.12).…”

Online and Offline Intervention for the Prevention of Postpartum Depression among Rural-to-Urban Floating Women: Study Protocol for a Randomized Control Trial

“…Systematic review and meta-analysis found from [7][8][9][10] that there have been various interventions for PPD, i.e., pharmacological interventions and nonpharmacological intervention. Although pharmacological method is an effective treatment for depression, mothers are often reluctant to take antidepressant medication due to concerns about breast milk transmission or potential side-effects on their babies [8,11]. Thus, it is important to evaluate the effects of nonpharmacologic interventions on postpartum women experiencing PPD.…”