Association of multimodal analgesic protocol with postpartum depression incidence and sleep quality in high-risk parturients.
Hui Zhang, Yan An Jiang, Huajun Fu, Lin Zhang, Gang Zhang
Frontiers in Medicine 2026 DOI: 10.3389/fmed.2026.1828838 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective cohort study Randomized Peer reviewed |
|---|---|
| Sample size | 161 |
| Population | High-risk parturients undergoing cesarean delivery |
| Interventions | Dexmedetomidine Esketamine |
| Dose | 0.25 mg/kg esketamine intraoperatively, followed by dexmedetomidine-esketamine patient-controlled analgesia for 48 h |
| Duration | 48-hour intervention, 6-week follow-up |
| Topics | Esketamine Depression |
| Keywords | Cesarean delivery Dexmedetomidine High-risk parturients Multimodal analgesia Postpartum depression Sleep quality |
| Key findings | A multimodal analgesic protocol combining dexmedetomidine and esketamine was associated with a 50% relative reduction in postpartum depression incidence at six weeks compared to standard sufentanil-based analgesia. |
Abstract
Postpartum depression (PPD) affects 10-20% of women after childbirth, with incidence reaching 30-50% in high-risk populations. Acute postoperative pain and sleep disturbance represent modifiable risk factors. This study evaluated whether a multimodal analgesic protocol combining dexmedetomidine and esketamine is associated with reduced PPD incidence in high-risk parturients undergoing cesarean delivery. This single-center, retrospective cohort study included 82 high-risk parturients who received intraoperative esketamine (0.25 mg/kg) followed by postoperative dexmedetomidine-esketamine patient-controlled analgesia for 48 h between January 2023 and December 2024. Historical controls (n = 79) from 2022 received standard sufentanil-based analgesia. The primary outcome was PPD incidence at 6 weeks (Edinburgh Postnatal Depression Scale >10). PPD incidence was significantly lower in the intervention group versus controls (14.6% vs. 29.1%; relative risk 0.50, 95% confidence interval 0.27-0.93; p = 0.028; number needed to treat 6.9). Edinburgh Postnatal Depression Scale (EPDS) score decreased more in the intervention group (-2.8 ± 3.4 vs. +0.6 ± 4.1; p < 0.001). Sleep quality at postoperative day 7 was better (Pittsburgh Sleep Quality Index 6.2 ± 2.8 vs. 8.9 ± 3.1; p < 0.001). Opioid consumption decreased by 21.2% (p < 0.001). Exploratory biomarker assessment in a subset suggested lower interleukin-6 and higher brain-derived neurotrophic factor (both p < 0.001), though these data were non-systematic. Psychotomimetic effects occurred in 8.5%, all transient. No significant differences in cardiovascular or respiratory adverse events were observed. A multimodal analgesic protocol incorporating dexmedetomidine-esketamine multimodal analgesic protocol was associated with lower postpartum depression incidence, better sleep quality, and acceptable safety in high-risk parturients. Randomized trials are needed to establish causality.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cites 6
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- Effect of esketamine on reducing postpartum pain and depression. World Journal of Clinical Cases March 6, 2025
- The effect of low-dose esketamine on maternal depression after cesarean delivery. Journal of psychosomatic obstetrics and gynaecology December 1, 2025
- Intraoperative Esketamine and Postpartum Depression Among Women With Cesarean Delivery: A Randomized Clinical Trial Obstetric Anesthesia Digest November 18, 2025
- Esketamine Nasal Spray: Rapid Relief for TRD and Suicide Prevention-Mechanisms and Pharmacodynamics. Neuropsychiatric Disease and Treatment 2024
and 1 more in the library