Association of multimodal analgesic protocol with postpartum depression incidence and sleep quality in high-risk parturients.

Abstract

<h4>Background</h4>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.<h4>Methods</h4>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 (<i>n</i> = 79) from 2022 received standard sufentanil-based analgesia. The primary outcome was PPD incidence at 6 weeks (Edinburgh Postnatal Depression Scale >10).<h4>Results</h4>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; <i>p</i> = 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; <i>p</i> < 0.001). Sleep quality at postoperative day 7 was better (Pittsburgh Sleep Quality Index 6.2 ± 2.8 vs. 8.9 ± 3.1; <i>p</i> < 0.001). Opioid consumption decreased by 21.2% (<i>p</i> < 0.001). Exploratory biomarker assessment in a subset suggested lower interleukin-6 and higher brain-derived neurotrophic factor (both <i>p</i> < 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.<h4>Conclusion</h4>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.

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