Effects of low-dose esketamine on postoperative pain, sleep quality, and inflammatory response after elective cesarean section: a randomized, double-blind, placebo-controlled trial
Abstract
<title>Abstract</title> <p>Background Clinical studies have demonstrated that esketamine effectively relieves postoperative pain and enhances sleep quality in patients undergoing cesarean delivery. However, the optimal dosage remains to be determined. This study aimed to evaluate the effects of low-dose esketamine on postoperative pain, sleep quality, inflammatory responses, and emotional status in women undergoing elective cesarean section. Methods A total of 124 women scheduled for cesarean delivery under neuraxial anesthesia were randomly assigned to the esketamine or control group, which received an intravenous bolus of esketamine (0.2 mg/kg) and an equivalent volume of 0.9% sodium chloride, respectively. The primary outcomes were resting and movement-evoked visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Secondary outcomes included the number of effective patient-controlled analgesia (PCA) presses, 24-h rescue analgesia rate, Pittsburgh Sleep Quality Index (PSQI) score, Insomnia Severity Index (ISI) score, serum interleukin-18 (IL-18) and C-reactive protein (CRP) concentrations, Edinburgh Postnatal Depression Scale (EPDS) score, and incidence of adverse events. Results The baseline characteristics were similar between groups. No significant differences were observed in the resting or movement-evoked VAS pain scores 2 h postoperatively. However, the esketamine group demonstrated significantly lower resting and active VAS scores at 6, 24, and 48 h postoperatively than the control group (P < 0.05). Furthermore, the esketamine group required fewer effective PCA bolus attempts within the first 24 h postoperatively and exhibited a notably lower rescue analgesia rate (10.0% vs. 24.6%, P = 0.034). Regarding secondary outcomes, the PSQI and ISI scores were markedly lower in the esketamine group on postoperative days 1 and 3. Serum inflammatory markers, including IL-18 and CRP, were significantly lower in the esketamine cohort 24 h post-surgery. Additionally, the EPDS scores were significantly lower in the esketamine group than in the control group at both 24 and 72 h postoperatively. Conclusions Low-dose esketamine (0.2 mg/kg) improved early postoperative analgesia and subjective sleep quality, was associated with lower postoperative IL-18 and CRP levels, and reduced early mood-related scores in women undergoing elective cesarean section without increasing adverse events. Trial registration Chinese Clinical Trial Registry ChiCTR2500099435.</p>
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