Esketamine for postoperative analgesia after cesarean section: Effects on pain, mood, sleep quality, and safety

This study aims to evaluate the clinical efficacy and safety of esketamine for postoperative analgesia in women undergoing cesarean section and explore its effects on mood (anxiety and depression) and sleep quality during the recovery period. This retrospective cohort study included 125 full-term pregnant women who underwent cesarean delivery at our hospital between January 2023 and June 2024. Based on the type of postoperative analgesia administered, patients were allocated to either an esketamine group (n = 64) or a conventional analgesia group (n = 61). Pain intensity (measured via Visual Analog Scale [VAS] scores at 4, 12, 24, and 48 hours post-surgery), mood indicators (anxiety and depression scores on postoperative days 3, 7, and 28), sleep quality (assessed using the Pittsburgh Sleep Quality Index), and the incidence of adverse events were recorded and analyzed. Patients receiving esketamine reported significantly lower VAS pain scores at all postoperative time points compared to those in the control group. Specifically, at 12 hours post-surgery, the resting VAS score was 2.13 ± 0.38 in the esketamine group versus 2.53 ± 0.51 in the control group (P < .001); at 24 hours, it was 1.78 ± 0.27 versus 2.01 ± 0.29 (P < .001), and at 48 hours, it was 1.41 ± 0.39 versus 1.72 ± 0.37 (P < .001). Anxiety and depression scores were consistently reduced in the esketamine group at all assessed time intervals (e.g., Edinburgh Postnatal Depression Scale score at 3 days: 8.95 ± 1.47 in the esketamine group versus 11.37 ± 2.71 in the control group, P < .001). Sleep quality, as reflected by Pittsburgh Sleep Quality Index scores, was significantly better in the esketamine group at 3 days (11.25 ± 1.07 vs 12.41 ± 2.43, P = .002), 1 week (10.13 ± 1.73 vs 11.53 ± 1.37, P < .001), and 4 weeks (9.78 ± 1.28 vs 10.51 ± 1.55, P = .011). No significant differences were observed between the 2 groups regarding adverse events, and no serious complications were noted in either group. Esketamine demonstrates superior efficacy in managing postoperative pain, alleviating anxiety and depression, and improving sleep quality after cesarean section, with no increase in adverse effects. These findings suggest that esketamine may serve as a valuable option for enhancing postoperative recovery in cesarean patients.