A single intravenous administration of a sub-anesthetic ketamine dose during the perioperative period of cesarean section for preventing postpartum depression: A meta-analysis.
Qiuwen Li, Sai-Ying Wang, Xi Mei
Psychiatry Research 2022 DOI: 10.1016/j.psychres.2022.114396 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Meta-analysis Peer reviewed |
|---|---|
| Sample size | 2,087 |
| Population | Women undergoing cesarean section |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Duration | Follow-up to 4 weeks postpartum; continuous 48 h postpartum administration in one comparison |
| Topics | Depression Esketamine Ketamine |
| Key findings | Ketamine reduced postpartum depression scores and prevalence within one week after cesarean delivery but showed no benefit at four weeks; overall adverse events did not differ significantly, though vomiting was more common with ketamine. The authors report efficacy emerging at 0.5 mg/kg and suggest continuous 48-hour postpartum analgesic-pump administration may be more effective than a single intraoperative injection. |
Abstract
The feasibility of intravenous ketamine administration during the perioperative period of cesarean section to prevent postpartum depression (PPD) has not been determined by meta-analysis. To evaluate the efficacy, safety and dose of prophylactic ketamine in offsetting PPD, we retrieved the following databases in English or Chinese from inception to December 2020: Pubmed, Embase, Web of Science, The Cochrane Library, CNKI, VIP and Wanfang. A total of 10 studies (9 RCTs and 1 retrospective study) were included with 2087 cases. Meta-analysis showed that in ketamine group, the score and the prevalence of PPD within 1 week postpartum were significantly reduced, whereas PPD score after 4 weeks postpartum showed no superiority. There was no significant difference in terms of total adverse events rate, although vomiting occurred more frequently in the ketamine group. In addition, we found that ketamine efficacy emerged at 0.5 mg/kg. By meta-regression, we observed that: (1) Age and BMI are negatively associated with mood response to ketamine. (2) An analgesic pump containing ketamine for continuous 48 h postpartum administration was more efficacious than an intravenous injection of ketamine during cesarean section. Current evidence shows ketamine could be efficacious and safe in the prophylactic management of PPD in women having a cesarean section.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.