Abstract / Summary
Abstract Background Cesarean section frequently leads to moderate-to-severe postoperative pain, enhanced perioperative inflammation and increased incidence of postpartum depression. Esketamine possesses analgesic, anti-inflammatory and psychotropic effects via inhibiting NMDA receptors. Although intravenous esketamine is commonly used for obstetric analgesia, the clinical value of epidural esketamine after cesarean delivery requires further verification. This study aims to evaluate the impacts of epidural esketamine on postoperative pain intensity, perioperative inflammatory indicators, postpartum depression and safety in cesarean section patients. Methods Eighty parturients scheduled for cesarean section under neuraxial anesthesia were randomly assigned to control group (Group C) and esketamine group (Group T) using a random number table method, with 40 patients in each group. All parturients received postoperative patient-controlled intravenous analgesia (PCIA). Before skin closure, each patient received a 5 mL epidural injection of the assigned study drug. Group C received 5 mL normal saline, and Group T received 0.2 mg/kg esketamine diluted to 5 mL. Resting Numerical Rating Scale (NRS) pain scores were recorded at 2, 6, 12, 24 and 48 h postoperatively. Dynamic pain and uterine contraction pain NRS scores, as well as the number of PCIA bolus requests, were documented at 24 h and 48 h after surgery. Venous blood samples were collected before and one day after surgery to measure serum cortisol, C-reactive protein (CRP) and interleukin-6 (IL-6) for evaluation of perioperative inflammatory status. The Edinburgh Postnatal Depression Scale (EPDS) was administered 1 day before operation, 1 week and 6 weeks after delivery to assess depressive symptoms and the incidence of postpartum depression. The incidences of adverse reactions including postoperative nausea and vomiting, pruritus and shivering, as well as psychiatric adverse reactions such as dizziness, drowsiness, irritability and emotional excitement, were recorded. Results Compared with Group C, Group T exhibited significantly lower resting NRS scores from 2 h to 48 h postoperatively, lower dynamic pain and uterine contraction pain NRS scores at 24 h and 48 h, and fewer rescue analgesia requirements within 48 h (all P < 0.05). Preoperative serum cortisol, CRP and IL-6 levels were comparable between the two groups ( P > 0.05). At 24 h postoperatively, serum cortisol, CRP and IL-6 concentrations in Group T were markedly lower than those in Group C ( P < 0.05). EPDS scores and the positive screening rate of postpartum depression at postoperative 1 week and 6 weeks were significantly lower in Group T ( P < 0.05). The incidences of postoperative nausea and vomiting, pruritus and shivering were similar between the two groups ( P > 0.05). The rates of psychiatric adverse events including dizziness, drowsiness, irritability, excitement and blurred vision were slightly higher in Group T, without statistically significant intergroup differences ( P > 0.05). Conclusion Single epidural administration of 0.2 mg/kg esketamine prior to skin closure enhances postoperative pain relief, suppresses perioperative inflammation, and alleviates postpartum depressive symptoms after cesarean section. The incidence of mild psychiatric side effects was slightly higher but not statistically significant. Epidural esketamine appears to be a safe adjuvant analgesic for parturients receiving cesarean delivery. Trial registration Chictr.org.cn identifier ChiCTR2400090341 (Date of registry: 27/09/2024, Retrospectively registered).