ObjectiveTo investigate the effects of a single intravenous injection of low-dose esketamine during cesarean section on postpartum depression in primiparas.

MethodsThis study is a prospective randomized controlled trial involving 106 primiparas who underwent scheduled intrathecal anesthesia for cesarean section at Xi'an International Medical Center Hospital from January 2021 to December 2023. The participants were randomly assigned to either the control group or the observation group, with 53 women in each group, using a random number table method. Both groups received the same type and method of anesthesia. In the observation group, 5 minutes after the delivery of the fetus and the clamping of the umbilical cord, a low dose of esketamine (0.2 mg/kg, dissolved in 10 mL of 0.9% sodium chloride injection) was administered intravenously. The control group received an equivalent volume of 0.9% sodium chloride injection as a placebo. The score of the Edinburgh Postnatal Depression Scale at various postpartum time intervals (3, 7, 14, 30, and 42 days), the incidence of postpartum depression, and any adverse drug reactions occurring within 3 days postoperatively were compared between the two groups. Additionally, the score of the Visual Analog Scale (VAS) for contraction pain was assessed.

ResultsThe scores of the Edinburgh Postnatal Depression Scale in the observation group at 3, 7, 14, 30, and 42 days postpartum were (6.23 ± 1.21), (5.82 ± 1.77), (6.14 ± 1.20), (5.33 ± 1.19), and (6.01 ± 1.23), respectively. These scores were significantly lower than those in the control group [(8.99 ± 1.28), (8.91 ± 2.11), (9.03 ± 1.94), (10.40 ± 2.68), (9.28 ± 1.84), t = 11.40, 8.16, 9.22, 12.58, 10.75, all P < 0.001]. The incidence of postpartum depression in the observation group at 7 and 14 days postpartum was significantly lower than that in the control group [3.77% (2/53) vs. 16.98% (9/53), 3.77% (2/53) vs. 15.09% (8/53), χ² = 4.97, 3.97, P = 0.026, 0.046]. There was no statistically significant difference in the incidence of adverse drug reactions within 3 days postoperatively between the two groups of women who underwent scheduled intrathecal anesthesia for cesarean section [15.09% (8/53) vs. 11.32% (6/53), χ² = 0.32, P = 0.566]. The scores of the Visual Analog Scale for contraction pain in the observation group at 3, 6, 12, and 24 hours postoperatively were (2.13 ± 0.28), (2.55 ± 0.33), (2.73 ± 0.35), and (3.06 ± 0.37), respectively. These scores were significantly lower than those in the control group [(4.35 ± 0.46), (5.43 ± 0.36), (5.68 ± 0.35), (5.26 ± 0.43), t = 30.01, 42.93, 43.38, 28.23, all P < 0.001].

ConclusionsA single intravenous injection of low-dose esketamine during cesarean section can effectively alleviate emotional distress in primiparas in the short term after surgery, which has significant clinical implications for reducing the incidence of postpartum depression.