The effect of an intravenous analgesic pump with esketamine on postoperative pain and postpartum depression in women with cesarean section

Abstract

Objective: This study aims to investigate the efficacy of an intravenous analgesic pump containing esketamine for postoperative pain relief and its impact on postpartum depression in women undergoing cesarean sections.

Methods: A retrospective analysis was conducted on 147 women who underwent cesarean deliveries at Xiamen Hospital of Traditional Chinese Medicine from April 2022 to May 2024. Based on different pain management protocols, the participants were divided into two groups: the observation group (n=81) and the control group (n=66). The observation group received intravenous esketamine post-delivery, followed by postoperative analgesia using a pain pump with esketamine and Sufentanil. Various outcomes were assessed, including Visual Analog Scale (VAS) pain scores, Edinburgh Postnatal Depression Scale (EPDS) scores, and serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), cortisol (Cor), and brain-derived neurotrophic factor (BDNF).

Results: At 12, 24, and 48 hours post-surgery, VAS pain scores (both resting and coughing) were significantly lower in the observation group compared to the control group (P<0.05). EPDS scores were significantly higher at 3, 7, and 42 days post-surgery in both groups compared to pre-surgery levels (P<0.05), with the observation group exhibiting significantly lower EPDS scores at 3 and 7 days (P<0.05). Serum levels of IL-6, TNF-α, and Cor were significantly reduced at 24 and 48 hours post-surgery in both groups, while BDNF levels were significantly elevated (P<0.05). At 24 and 48 hours, the observation group had significantly lower levels of IL-6, TNF-α, and Cor, along with higher BDNF levels, compared to the control group (P<0.05). No significant differences in adverse reactions were observed between the two groups (P>0.05).

Conclusion: Esketamine-based postoperative analgesia for cesarean section effectively reduces perioperative pain, alleviates postpartum depression, mitigates inflammatory and stress responses, and has certain neuroprotective effects. Its safety profile supports its potential for broader clinical use.

Keywords: Esketamine; caesarean section; intravenous analgesia; postpartum depression; postpartum pain.

Figure 1

A comparison of postoperative resting pain levels between the two groups. Note: Compared with the control group, *P<0.05.

Figure 2

A comparison of the degree of postoperative cough-induced pain between the two groups. Note: Compared with the control group, *P<0.05.

Figure 3

Scores of postpartum depression levels for the two groups. Note: Compared with the group before surgery, *P<0.05; compared with the control group of the same period, #P<0.05.

Figure 4

Comparison of serum indicators between the two groups of postpartum women. Note: Compared with the group before surgery, *P<0.05; compared with the control group of the same period, #P<0.05.