Effect Of Postoperative Analgesia With Dexketamine On Puerperal Depression After Cesarean Section

Objective:Puerperal depression is a common complication after cesarean section.The Edinburgh Postnatal Depression Scale(EPDS)can be used to screen for puerperal depression.S-ketamine is one of chiral cyclohexanone with strong analgesic effect and has been approved for the treatment of depression.The aim of this study was to evaluate the effect of dexketamine used for postoperative analgesia after cesarean section on the puerperium depression.Method:1.Puerperae scheduled for cesarean under epidural anesthesia with the ASA scored Ⅰ-were randomly divided into two groupsⅡ :Control group(Group C)and Study group(Group S).2.After surgery,patients in both groups received a PCIA pump.The formula of the Group C: sufentanyl 2 μg/kg + tropisetron 10 mg,Group S: sufentanyl 2 μg/kg+dexketamine 0.5 mg/kg+ tropisetron 10 mg.The total volume of PCIA in the two groups was 100 m L,the infusion rate was 2 m L/h,and the patient controlled analgesia maintained to 48 h after surgery.3.The EPDS scores were recorded before,3 days,14 days and 28 days after surgery and the incidence of depression at 3days,14 days,and 28 days postpartum.4.Analgesia and Sedation at 4 hours(T1),8 hours(T2),12 hours(T3),24 hours(T4),and 48 hours(T5)after obstetrics were evaluated and recorded by Visual Analogue Scale(VAS)and Ramsay Sedation Scale score(RSS).5.The incidence of postoperative adverse reactions was also recorded.Result:1.General data: A total of 275 patients were included in this study,153 women in the C group and 122 women in the S group.No significant difference was found in the general data between the two groups.2.Compared with the Group C,the EPDS score of the Group S was lower at 3and 14 days after operation(P<0.05),the EPDS scores at 28 days after surgery were no significantly different between the two groups(P>0.05).3.The incidence of depression at postoperative 3 and 14 days in the Group S was lower than that in Group C(P<0.05),there was no significant difference in the incidence of depression after 28 days between the two groups(P>0.05).4.The EPDS scores of the Group C increased at 3,14,and 28 days after surgery(P<0.05),The EPDS scores of the Group S at 3 and 14 days after surgery were lower than those before surgery(P<0.05),and didn’t significantly decreased in EPDS scores at 28 days after surgery(P>0.05).5.The VAS scores at 4h(T1),8h(T2),12h(T3),24h(T4)and 48h(T5)in Group S were all lower than those in Group C(P<0.05);The RSS score of 24 h after operation(T4)in the study group was higher than that in the control group(P<0.05),and there was no significant difference in the sedative effects at 4h(T1),8h(T2),12h(T3)and 48h(T5)between the two groups(P>0.05).6.No patient appeared adverse reactions of diplopia,muscle tremor or hallucination in both two groups,and there were no significant differences in incidence of nausea,vomiting,dizziness,headache and drowsiness between the two groups(P>0.05).Conclusion:1.EPDS score will be increased after cesarean section.Dexketamine used for PCIA can significantly relieve postoperative pain,and can also reduce Edinburgh depression score and incidence of postpartum depression within 14 days but not at28 days after surgery.2.Dexketamine does not increase the incidence of postoperative adverse reactions in patients.