Perioperative esketamine may improve postoperative pain and mood outcomes after cesarean section

1. Intravenous esketamine provides effective adjunctive analgesia after cesarean delivery while also reducing postoperative inflammation and mood-related complications.

2. Esketamine may be a useful component of multimodal postoperative management in obstetric anesthesia beyond pain control alone.

Evidence Rating Level: 1 (Excellent) 

Postoperative pain following cesarean section is common and closely linked to inflammation, anxiety, depression, sleep disturbance, and central sensitization. This single-center, randomized, double-blind, placebo-controlled trial evaluated whether perioperative esketamine improves postoperative pain and related outcomes in women undergoing elective cesarean delivery under combined spinal-epidural anesthesia. One hundred term pregnant women were randomized to receive intravenous esketamine (0.5 mg/kg after cord clamping, followed by esketamine-containing patient-controlled intravenous analgesia) or placebo with standard opioid-based analgesia. The primary outcome was the maximum numeric rating scale pain score within 24 hours postoperatively. Secondary outcomes included pain at rest, with movement, and visceral pain at multiple time points, analgesic use, pressure pain threshold and tolerance, serum C-reactive protein, and rates of anxiety, depression, and sleep disorders. Ninety-eight participants completed the study. The esketamine group had significantly lower maximum pain scores within 24 hours and consistently lower rest, movement, and visceral pain scores at all assessed intervals. Time to first patient-controlled analgesia use was prolonged, and postoperative serum C-reactive protein levels were lower, indicating reduced inflammation. Esketamine was also associated with significantly lower rates of postoperative anxiety, depression, and sleep disturbance. There were no significant differences in hyperalgesia measures or adverse effects between groups. Overall, perioperative esketamine provided effective multimodal benefits after cesarean delivery.

Click here to read this study in PLOS One

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