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Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial
BACKGROUND: Postpartum depression (PPD) is a common mental disease happens in perinatal period. Ketamine as an anesthesia and analgesia drug has been used for a long time. In recent years, ketamine is proved to have an antidepression effect with a single administration. We hypothesized that intraope...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507540/ https://www.ncbi.nlm.nih.gov/pubmed/32812388 http://dx.doi.org/10.1002/brb3.1715 |
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author | Yao, Jiaxin Song, Tingting Zhang, Yue Guo, Nan Zhao, Ping |
author_facet | Yao, Jiaxin Song, Tingting Zhang, Yue Guo, Nan Zhao, Ping |
author_sort | Yao, Jiaxin |
collection | PubMed |
description | BACKGROUND: Postpartum depression (PPD) is a common mental disease happens in perinatal period. Ketamine as an anesthesia and analgesia drug has been used for a long time. In recent years, ketamine is proved to have an antidepression effect with a single administration. We hypothesized that intraoperative ketamine can reduce postpartum depressive symptoms after cesarean delivery. METHODS: In a randomized, double‐blind, placebo‐controlled study trail, healthy women scheduled for cesarean delivery were randomly assigned to receive intravenous ketamine (0.25 mg/kg diluted to 5 ml with 0.9% saline) or placebo (5 ml of 0.9% saline) within 5 min following clamping of the neonatal umbilical cord. The primary outcome was the degree of postpartum depressive symptoms, which was evaluated by Edinburgh Postnatal Depression Scale (EPDS, a threshold of 9/10 was used) at 1 week, 2 weeks, and 1 month after delivery. The secondary outcome was the numerical rating scale (NRS) score of pain at 2 days postpartum. This trail is registered in the Chinese Clinical Trial Registry, number ChiCTR1900022464. RESULTS: Between 26 January 2019 and 15 July 2019, 502 subjects were screened and 330 were randomly allocated: 165 (50%) to the ketamine group and 165 (50%) to the placebo group. There were significant differences in the degree of postpartum depressive symptoms between subjects in the ketamine group and the placebo group at 1 week postpartum (13.1% vs. 22.6%, respectively; p = .029). However, no difference was found between subjects in the two groups at 2 weeks (11.8% vs. 16.8%, respectively; p = .209) and 1 month postpartum (10.5% vs. 14.2%, respectively; p = .319). The NRS score of wound pain (3.0 ± 0.9 vs. 4.0 ± 1.0, respectively; p < .001) and uterine contraction pain (3.0 ± 0.9 vs. 4.1 ± 0.9, respectively; p < .001) was lower in the ketamine group at 2 days postpartum compared with placebo group. The prevalence of headache, hallucination, and dizziness was higher in the ketamine group than the placebo group during the operation. CONCLUSIONS: Operative intravenous ketamine (0.25 mg/kg) can reduce the postpartum depressive symptoms for 1 week. The long‐time effect is remained to be seen. |
format | Online Article Text |
id | pubmed-7507540 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-75075402020-09-29 Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial Yao, Jiaxin Song, Tingting Zhang, Yue Guo, Nan Zhao, Ping Brain Behav Original Research BACKGROUND: Postpartum depression (PPD) is a common mental disease happens in perinatal period. Ketamine as an anesthesia and analgesia drug has been used for a long time. In recent years, ketamine is proved to have an antidepression effect with a single administration. We hypothesized that intraoperative ketamine can reduce postpartum depressive symptoms after cesarean delivery. METHODS: In a randomized, double‐blind, placebo‐controlled study trail, healthy women scheduled for cesarean delivery were randomly assigned to receive intravenous ketamine (0.25 mg/kg diluted to 5 ml with 0.9% saline) or placebo (5 ml of 0.9% saline) within 5 min following clamping of the neonatal umbilical cord. The primary outcome was the degree of postpartum depressive symptoms, which was evaluated by Edinburgh Postnatal Depression Scale (EPDS, a threshold of 9/10 was used) at 1 week, 2 weeks, and 1 month after delivery. The secondary outcome was the numerical rating scale (NRS) score of pain at 2 days postpartum. This trail is registered in the Chinese Clinical Trial Registry, number ChiCTR1900022464. RESULTS: Between 26 January 2019 and 15 July 2019, 502 subjects were screened and 330 were randomly allocated: 165 (50%) to the ketamine group and 165 (50%) to the placebo group. There were significant differences in the degree of postpartum depressive symptoms between subjects in the ketamine group and the placebo group at 1 week postpartum (13.1% vs. 22.6%, respectively; p = .029). However, no difference was found between subjects in the two groups at 2 weeks (11.8% vs. 16.8%, respectively; p = .209) and 1 month postpartum (10.5% vs. 14.2%, respectively; p = .319). The NRS score of wound pain (3.0 ± 0.9 vs. 4.0 ± 1.0, respectively; p < .001) and uterine contraction pain (3.0 ± 0.9 vs. 4.1 ± 0.9, respectively; p < .001) was lower in the ketamine group at 2 days postpartum compared with placebo group. The prevalence of headache, hallucination, and dizziness was higher in the ketamine group than the placebo group during the operation. CONCLUSIONS: Operative intravenous ketamine (0.25 mg/kg) can reduce the postpartum depressive symptoms for 1 week. The long‐time effect is remained to be seen. John Wiley and Sons Inc. 2020-08-18 /pmc/articles/PMC7507540/ /pubmed/32812388 http://dx.doi.org/10.1002/brb3.1715 Text en © 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Yao, Jiaxin Song, Tingting Zhang, Yue Guo, Nan Zhao, Ping Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title | Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title_full | Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title_fullStr | Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title_full_unstemmed | Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title_short | Intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: A double‐blind, randomized clinical trial |
title_sort | intraoperative ketamine for reduction in postpartum depressive symptoms after cesarean delivery: a double‐blind, randomized clinical trial |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507540/ https://www.ncbi.nlm.nih.gov/pubmed/32812388 http://dx.doi.org/10.1002/brb3.1715 |
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