The effect of esketamine on sleep disorders in parturients undergoing cesarean section under general anesthesia: a...

This study evaluated the primary effect of esketamine on postoperative sleep disorder (PSD) at 3 days after surgery, as well as its secondary effects on pain and depressive symptoms.

A total of 140 parturients who underwent elective cesarean delivery under general anesthesia were enrolled and randomized 1:1 to the esketamine or placebo group. After delivery, blinded anaesthesiologists administered a continuous infusion of esketamine (0.3 mg/kg/h) or an equal volume of normal saline. We compared baseline data, anesthesia/surgery indicators, postoperative PSQI scores, sleep NRS scores, incidences of PSD, pain NRS scores and postpartum depression (EPDS) between the groups. We also evaluated adverse reactions and maternal-neonatal complications and performed multivariate logistic regression for PSD risk factors.

At 3 and 7 days after surgery, the PSQI scores, NRS scores, incidence of PSD, and incidence of postpartum depression in the esketamine group were significantly lower than those in the control group (P < 0.05). The pain NRS scores at 24, 48, and 72 h postpartum and the rate of rescue analgesia within 72 h were also significantly lower in the esketamine group (P < 0.05). Intraoperative consumption of propofol and remifentanil was significantly lower in the esketamine group than in the control group (P = 0.038 and P < 0.001, respectively). Logistic regression revealed that a 24-h postpartum pain NRS score (OR = 1.485, 95% CI: 1.058-2.084, P = 0.022) and antepartum sleep disorder (OR = 4.757, 95% CI: 2.241-10.098, P < 0.001) were risk factors for PSD in parturients who underwent cesarean delivery under general anesthesia.

Continuous intraoperative esketamine infusion reduced the incidence of 3-day postoperative sleep disorders and improves sleep quality, while concurrently enhancing analgesic efficacy and ameliorating postpartum depression outcomes in parturients undergoing cesarean section under general anesthesia. Clinicians should prioritize screening for prenatal sleep disturbances and implement early preventive interventions.

https://clinicaltrials.gov/, Identifier [ChiCTR23000 78490].