Esketamine pretreatment during cesarean section reduced the incidence of PPD: A randomized controlled trail
Shixia Xu, Jiaojiao Yang, Jing Li, Min Zhang, Jie Sun, Qingren Liu, Jianjun Yang
preprint DOI: 10.21203/rs.3.rs-3482662/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial |
|---|---|
| Sample size | 319 |
| Population | Parturients undergoing cesarean delivery |
| Interventions | Esketamine Saline |
| Dose | 0.2 mg/kg |
| Duration | 40-minute infusion; follow-up at 4 days and 42 days after surgery |
| Measures | Amsterdam Anxiety and Information Scale (APAIS), Edinburgh postnatal depression scale (EPDS), Pain Numerical Rating Scale (NRS) |
| Topics | Esketamine Ketamine |
| Key findings | Intraoperative esketamine (0.2 mg/kg) reduced the incidence of postpartum depression at 4 days after cesarean delivery (13.8% vs 23.1%) but not at 42 days, and lowered pain scores at 6, 12, and 24 hours, while increasing maternal side effects such as dizziness, blurred vision, illusion, and drowsiness. |
Abstract
Abstract Background Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD.
Methods: All the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded.
Results: A total of 319 parturients were analyzed in the study. The incidence rate of PPD (EPDS score > 9) in the esketamine group was decreased than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430 ) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05).
Conclusions: Intraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased.
Trial Registration: Registered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.
Comparable studies
Other randomized controlled trials on esketamine, most cited first.
Citations in the library
Cites 9
- Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial American Journal of Psychiatry August 28, 2013
- Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial American Journal of Psychiatry December 5, 2017
- Molecular mechanisms of the rapid-acting and long-lasting antidepressant actions of (R)-ketamine. Biochemical Pharmacology July 1, 2020
- Long-term safety of ketamine and esketamine in treatment of depression Expert Opinion on Drug Safety April 13, 2022
- Low-dose S-ketamine exerts antidepressant-like effects via enhanced hippocampal synaptic plasticity in postpartum depression rats. Neurobiology of Stress 2022
and 4 more in the library