Effects Of Esketamine On Pain,inflammatory Response And Postoperative Depression In Patients Undergoing Cesarean Section

Objective: To investigate the effects of esketamine on perioperative hemodynamics,pain response,inflammatory response,cranial nerves function protection and postoperative depression in patients undergoing cesarean section.Methods: 60 patients undergoing cesarean section were selected and randomly divided into the control group(group C)and the esketamine group(group K),with 30 patients in each group.Patients in group K were intravenously pumped with esketamine immediately after the delivery of the fetus at a dose of 0.5mg/kg,and the infusion was completed within 30 min(1mg/m L).The patient-controlled intravenous analgesia(PCIA)was connected after the operation.The formula was: fentanyl 0.5mg,esketamine 1mg/kg,dexamethasone 10 mg.Patients in group C were intravenously pumped with normal saline immediately after delivery of the fetus.The pump speed was set as the same as those in group K.PCIA was performed after operation.The formula was: fentanyl 0.5mg and dexamethasone 10 mg.The venous access of patients in two groups were opened and non-invasive blood pressure,heart rate,pulse oxygen saturation and electrocardiogram were monitored after entering the operating room.The patients in two groups with continuous nasal catheter oxygen(2.0-5.0L/min)were taken the left lateral decubitus position,routinely disinfected,spread towels,and carried out subarachnoid puncture in the L3-4 space.After the cerebrospinal fluid outflow,0.375% bupivacaine was given with 2m L.The operation was started after the anesthesia level was satisfactory(maintaining the anesthesia level <T6).The blood pressure(BP)and heart rate(HR)of the patients in the two groups were recorded at the anesthesia in the operating room,the fetus delivered,and the end of operation.The operation duration and intraoperative fluid infusion volume were recorded.The visual analogue scores(VAS)of resting and coughing of patients were evaluated at four time points: 6h,12 h,24h and 48 h after the operation.Peripheral venous blood(3-5m L)was extracted at the anesthesia,in the operating room,24 h and 48 h after the end of the operation.The levels of brain derived neurotrophic factor(BDNF),cortisol(Cor),interleukin-6(IL-6)and tumor necrosis factor(TNF)were detected by ELISA.The edinburgh postpartum depression scale(EPDS)scores were evaluated at 1 day before delivery,3 days after delivery,1 week after delivery,and 4 weeks after delivery.The adverse reactions occurred within 48 hours after operation were recorded.Results:(1)There were no significant differences in the body mass index(BMI),age,ASA degrade,the time of operation,and intraoperative fluid infusion volume in two groups(P>0.05).(2)Compared with group C,the BP increased(P<0.05)and the HR decreased(P<0.05)in group K at the end of operation.(3)Compared with group C,the coughing and resting VAS scores decreased at 12 h,24h,and 48 h after operation in group K(P<0.05).There were no significant differences in the coughing and resting VAS scores at 6h after operation in two groups(P>0.05).(4)Compared with the time anesthesia in the operating room,the levels of Cor increased at the end,24 h,48h after operation in two groups(P<0.05).Compared with group C,the levels of Cor decreased in group K at the end,24 h,48h after operation(P<0.05).(5)Compared with the time anesthesia in the operating room,the levels of BDNF decreased at the end,24 h,48h after operation in two groups(P<0.05).Compared with group C,the levels of BDNF increased in group K at the end,24 h,48h after operation(P<0.05).(6)Compared with the time anesthesia in the operating room,the levels of IL-6 and TNF-α increased at the end,24 h,48h after operation in two groups(P<0.05).Compared with group C,the levels of IL-6 and TNF-α decreased in group K at the end,24 h,48h after operation(P<0.05).(7)Compared with the time 1 day before delivery,the EPDS scores increased at 3 days,1 week,and 4 weeks after delivery in two groups(P<0.05).Compared with group C,the EPDS scores decreased in group K at 3 days,1 week,and 4 weeks after delivery(P<0.05).Conclusions:(1)Esketamine can improve perioperative pain response in patients undergoing cesarean section;(2)Esketamine can improve the inflammatory response(IL-6,TNF-α)in patients with cesarean section;(3)Esketamine can improve the stress response(Cor)in patients with cesarean section;(4)Esketamine can improve cranial nerves function(BDNF)in patients with cesarean section;(5)Esketamine can improve postoperative depression in patients with cesarean section.