Effect of low-dose esketamine combined with labour analgesia on postpartum depression in spontaneous labour: a prospective case-control study

Purpose: To evaluate the effect of a single intravenous low-dose esketamine combined with labour analgesia on the occurrence of postpartum depression in patients with spontaneous labour. Methods: Female patients in labour were divided into a group of esketamine combined with labour analgesia (group A, n = 116), a group with labour analgesia alone (group B, n = 132) and a control group (group C, n = 51) according to the mode of analgesia. The Edinburgh Postpartum Depression Scale (EPDS) and visual analog scale (VAS) scores were collected at different time points for all three groups. Serum was also collected from patients before and after delivery to detect serum sex hormone changes. Results: This clinical study was a prospective, randomised, double-blind trial. A total of 299 patients were enrolled in the study. Cross-sectional analysis showed no significant differences in EPDS scores or incidence of depression between the three groups in postpartum period, or at 1, 7 or 42 days postpartum. There were no statistically significant differences in VAS scores at 2 hours postpartum, 1 day, 2 days and 7 days postpartum. No significant differences were seen in the levels of oestrogen, progesterone, 5hydroxytryptamine and serum cortisol before delivery between the three groups. After delivery, serum cortisol levels were higher in the labour analgesia alone group than in the esketamine combined with labour analgesia group and the control group ( P  < 0.001). Longitudinal analysis showed that EPDS and VAS scores improved significantly over time in postpartum period for both combined esketamine and labour analgesia alone ( P  < 0.001), but no significant change was seen in the control group. This improvement was possibly associated with a decrease in postpartum oestrogen levels and an increase in serum cortisol levels ( P  < 0.001). Conclusion: In this study, the combination of esketamine with labour analgesia did not reduce the incidence of depression and VAS scores at 1, 7 or 42 days postpartum.