The Effect Of Sub-anesthesia Doses Of Esketamine In The Prevention Of Postpartum Depression And Enhancement Of Postoperative Analgesia:A Randomized,Controlled Clinical Trial

Objective To explore the effect of Sub-Anesthesia doses of esketamine in the improvement of the mood and prevention of the occurrence of postpartum depression in perioperative puerpera,with the effect on reducing the acute pain after obstetrics and promoting the rapid recovery of puerpera.Methods Ninety cases of full-term pregnant women who underwent cesarean section under combined spinal and epidural anesthesia in The First Affiliated Hospital of Jinan University were randomly divided into two groups,45 people in each group.Esketamine group(Group E):0.25 mg/kg esketamine was injected intravenously 10 minutes after delivery(pump within 10minutes).Control group(Group C): 20 ml normal saline was injected intravenously 10 minutes after delivery(pump within 10 minutes).The Edinburgh Postpartum Depression Scale(EPDS)and Patient Health Questionnaire(PHQ-9)were used to evaluate the maternal depression at 3days and 6 weeks postpartum.Numeral pain score(NRS)was used to evaluate the pain degree at the end of surgery,1,6,12,24,48 hours and 6 weeks after delivery and record the rescue analgesia.The changes of vital signs at each time point during the operation were monitored,and intraoperative sedation,anesthesia effect,use of vasoactive drugs,adverse reactions,postoperative complications,time of first getting out of bed,time of discharge,anesthesia satisfaction were also recorded.Results There was no significant difference between the two groups in basic clinical data,intraoperative anesthesia effect,hemodynamic changes,perioperative blood loss,time of first getting out of bed and discharge,anesthesia satisfaction(P>0.05).There was no significant difference in EPDS and PHQ-9 scores and the proportion of EPDS≥10 and PHQ-9≥5between the two groups at 3 days and 6 weeks after surgery(P>0.05);subgroup analysis of prenatal EPDS≥10 or prenatal EPDS < 10 subgroup showed there was no significant difference in the EPDS scores and proportion of EPDS≥10 at 3 days and 6 weeks after surgery between the two groups(P>0.05).The NRS score of resting incision 6 hours after operation in the Group E was lower than that in the Group C(P<0.05);the highest score of resting incision NRS in the Group E was lower than that in the Group C(P<0.05);there was no significant difference in NRS scores of uterine contractions pain between the two groups at each time points(P > 0.05).The proportion of Ramsay sedation score=3 in Group E was higher than Group C at 30 minutes after administration and at the end of operation(P<0.05).The incidence of nausea in the Group E was lower than that in the Group C,and the incidence of dizziness and dreaming was higher than that in the Group C(P < 0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Intravenous injection of 0.25 mg/kg esketamine during cesarean section can not effectively improve mood at 3 days after obstetrics and reduce the incidence of postpartum depression,but can reduce the degree of postpartum pain and enhance the effect of postpartum analgesia.