The impact of esketamine combined with butorphanol on postoperative analgesia and maternal psychological status after cesarean section: A randomized controlled study.

Abstract

<h4>Background</h4>Cesarean delivery is a highly invasive procedure that causes moderate to severe pain. Persistent postoperative pain affects the parturients' rapid postoperative recovery. Therefore, we aim to investigate the efficacy and safety of esketamine in postoperative analgesia after cesarean section.<h4>Methods</h4>This clinical study, conducted from January 2022 to August 2022, was randomized, controlled, double-blind and approved by the Ethics Committee of Shiyan Renmin Hospital. Group S received intraoperative esketaimine infusion with 0.15 mg/kg/h and postoperative 0.2 mg/kg butorphanol + 2 mg/kg esketaimine for patient-controlled intravenous analgesia (PCIA). Group C received the same volume of 5 % glucose infusion and postoperative butorphanol 0.2 mg/kg for PCIA. The primary outcome was postoperative analgesic effectiveness as reflected by the number of analgesic pumps pressed during 24 h postoperative period by patients. The secondary outcomes included the VAS scores of postoperative pain, Edinburgh Postnatal Depression Scale (EPDS) scores, neonatal Apgar scores, the time to first ambulation, the gut functional recovery time, the rescue analgesic treatments, and adverse effects.<h4>Results</h4>A total of 160 parturients participated in the study, and ultimately, 155 patients were included in the final analysis. There was no statistically significant difference in the number of PCA presses between group C [12 (6-18)] and group S [10 (5-22.25)] during 24 h after surgery [P = 0.98, 95 % CI (-3-3)]. The differences in VAS scores between the two groups were not statistically significant at 8 h [P = 0.07, 95 % CI (0-1)], 24 h [P = 0.06, 95 % CI (0-1)], and 96 h [P = 0.09, 95 % CI (0-0)] postoperatively. The EPDS scores of Group S at postoperative 8 h, 24 h, 96 h, and one week were lower than those of the group C (P < 0.001). The incidence of dizziness was higher in Group S [P < 0.05, RR = 0.270, 95 % CI (0.09-0.78)].<h4>Conclusions</h4>The Supplementation of esketamine during the perioperative period does not improve postoperative analgesia after a cesarean section. But esketamine may improve maternal emotional state up to one week after surgery.

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