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| Effects of esketamine combined with nalbuphine for patient-controlled intravenous analgesia of women on their analgesia, recovery quality, and postpartum depression after cesarean section |
| Dazhou Central Hospital, Dazhou, Sichuan Province, 635000 |
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Abstract To investigate the effects of esketamine combined with nalbuphine for patient -controlled intravenous analgesia (PCIA) of women on their analgesia, recovery quality, and postpartum depression after cesarean section. Methods: A total of 240 women after cesarean section were randomly divided into two groups (120 cases in each group) from January 2021 to December 2022. At the end of the cesarean section, the women in both groups were given PCIA for analgesia to postoperative 48h. The women in the control group were given PCIA with nalbuphine 2 mg/kg in normal saline 200 ml, and the women in the experimental group were given PCIA with nalbuphine 2 mg/kg combined with esketamine 1 mg/kg in normal saline 200 ml. The visual analogue scale (VAS) scores at postoperative 6h, 12h, 24h, and 48h and the recovery situation of the women in the two groups were recorded. The serum prolactin (PRL) level of the women in the two groups at 1 h before operation, or at 24 h or 48 h after operation was measured. The score by 40-item quality of recovery scale (QoR-40) of the women in the two groups in 5 days after operation was performed to evaluate their overall recovery situation. The incidences of the postpartum depression of the women in the two groups in 3 days, 7 days, and 6 weeks after operation were counted. The adverse reactions of the women in the two groups within 48h after operation were observed. Results: The VAS scores (both at resting and active) of the women in the experimental group at 6-48h after operation were significantly lower than those of the women in the control group. The time of getting out of bed (13.45±2.39h), the time of anal exhaust (21.45±5.41h), and the time of lactation initiation (24.22±5.44h) of the women in the experimental group were significantly shorter than those (14.78±3.14h, 23.78±4.62, and 29.35±5.78h) of the women in the control group. The lactation times (8.25±1.76 times) of the women in the experimental group in 48h after operation was significantly higher than that (6.49±1.58 times) of the women in the control group. The PRL level of the women in the experimental group at 24h and 48h after operation was significantly higher than that of the women in the control group. The score of QoR-40 (175.12±5.39 points) of the women in the experimental group in the 5th day after operation was significantly higher than that (168.66±5.67 points) of the women in the control group. The incidences of the postpartum depression of the women in the experimental group in 3 and 7 days after operation (5.8% and 9.2%) were significantly lower than those (17.5% and 22.5%) of the women in the control group (all P＜0.05). There was no significant difference in the adverse reactions rate (17.5% vs.16.7%) of the women within 48h after operation between the two groups (P＞0.05). Conclusion: Esketamine combined with nalbuphine for PCIA of the women after cesarean section can not only has better analgesic effect, but also reduce the incidence of the postpartum depression and improve the quality of postoperative recovery of the women.
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