Journal of Clinical Medicine Research

Purpose: To evaluate the effects of different esketamine doses on postoperative analgesia and postpartum depression after cesarean section (CS). Methods: In this randomized, double-blind, placebo-controlled trial, 240 singleton parturients (ASA I-II) undergoing elective CS under combined spinal-epidural anesthesia were allocated to four groups: control (C) and three esketamine dose groups (E0.5, E1.0, E1.5) for patient-controlled intravenous analgesia (PCIA). The Edinburgh Postnatal Depression Scale (EPDS) was assessed preoperatively and at 3, 7, and 42 days postoperatively. Pain scores (4 h, 8 h, 12 h, 24 h, and 48 h postoperatively), adverse effects, and exclusive breastfeeding (72 h postoperatively) were recorded. Results: Postoperative analgesia for cesarean deliveries was effective in all four groups, but the E1.0 group showed the best analgesic effect, the lowest incidence of adverse reactions, and the highest breastfeeding rate (p<0.05). Postpartum EPDS values were significantly higher than those in prepartum in all four groups (p<0.05). Conclusion: Esketamine was safer and more effective in the E1.0 group for PCIA after CS, with the lowest incidence of adverse effects and highest breastfeeding rate.