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

Wang, Wei; Xu, Hua; Ling, Bin; Chen, Qing; Lv, Jie; Yu, Wenli

doi:10.1097/md.0000000000032010

Cited by 32 publications

(30 citation statements)

References 21 publications

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“…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 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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BackgroundDepressive symptoms are common among patients with lung cancer. We aimed to assess the effects of esketamine on postoperative depressive symptoms after thoracoscopic lung cancer surgery.MethodsIn this randomized, double-blind, placebo-controlled trial, 156 patients undergoing thoracoscopic lung cancer surgery were randomly allocated in a 1:1 ratio to receive intravenous esketamine (intraoperatively and in patient-controlled analgesia until 48 h postoperatively) or normal saline placebo. The primary outcome was the proportion of patients with depressive symptoms at 1 month postoperatively, assessed using the Beck Depression Inventory-II (BDI-II). Secondary outcomes included depressive symptoms at 48 h postoperatively, hospital discharge and 3 months postoperatively, BDI-II scores, anxious symptoms, Beck Anxiety Inventory scores, Quality of Recovery-15 (QoR-15) scores, and 1- and 3-month mortality.Main resultsA total of 151 patients (75 in the esketamine group and 76 in the normal saline group) completed the 1-month follow-up. The esketamine group had a significantly lower incidence of depressive symptoms at 1 month compared to the normal saline group (1.3% vs. 11.8%; risk difference = −10.5, 95%CI = −19.6% to −0.49%; p = 0.018). After excluding patients without lung cancer diagnosis, the incidence of depressive symptoms was also lower in the esketamine group (1.4% vs. 12.2%; risk difference = −10.8, 95%CI = −20.2% to −0.52%; p = 0.018). The secondary outcomes were similar between groups, except that the esketamine group had higher QoR-15 scores at 1 month postoperatively (median difference = 2; 95%CI = 0 to 5; p = 0.048). The independent risk factors for depressive symptoms were hypertension (odds ratio = 6.75, 95%CI = 1.13 to 40.31; p = 0.036) and preoperative anxious symptoms (odds ratio = 23.83, 95%CI = 3.41 to 166.33; p = 0.001).ConclusionPerioperative administration of esketamine reduced the incidence of depressive symptoms at 1 month after thoracoscopic lung cancer surgery. History of hypertension and preoperative anxious symptoms were independent risk factors for depressive symptoms.Clinical trial registration: Chinese Clinical Trial Registry http://www.chictr.org.cn, Identifier (ChiCTR2100046194).

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Gao¹,

Dai²,

Duan³

et al. 2023

Preprint

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Purpose To evaluate the effect of a single intravenous low-dose esketamine combined with labour analgesia on the occurrence of postpartum depression in patients with spontaneous labour.Methods Female patients in labour were divided into a group of esketamine combined with labour analgesia (group A, n = 116), a group with labour analgesia alone (group B, n = 132) and a control group (group C, n = 51) according to the mode of analgesia. The Edinburgh Postpartum Depression Scale (EPDS) and visual analog scale (VAS) scores were collected at different time points for all three groups. Serum was also collected from patients before and after delivery to detect serum sex hormone changes.Results This clinical study was a prospective, randomised, double-blind trial. A total of 299 patients were enrolled in the study. Cross-sectional analysis showed no significant differences in EPDS scores or incidence of depression between the three groups in postpartum period, or at 1, 7 or 42 days postpartum. There were no statistically significant differences in VAS scores at 2 hours postpartum, 1 day, 2 days and 7 days postpartum. No significant differences were seen in the levels of oestrogen, progesterone, 5hydroxytryptamine and serum cortisol before delivery between the three groups. After delivery, serum cortisol levels were higher in the labour analgesia alone group than in the esketamine combined with labour analgesia group and the control group (P < 0.001). Longitudinal analysis showed that EPDS and VAS scores improved significantly over time in postpartum period for both combined esketamine and labour analgesia alone (P < 0.001), but no significant change was seen in the control group. This improvement was possibly associated with a decrease in postpartum oestrogen levels and an increase in serum cortisol levels (P < 0.001).Conclusion In this study, the combination of esketamine with labour analgesia did not reduce the incidence of depression and VAS scores at 1, 7 or 42 days postpartum.

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“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Kearns

Nelson

2023

JAMA Netw Open

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

Cited by 32 publications

References 21 publications

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

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

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

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

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