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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...

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Autores principales: Yao, Jiaxin, Song, Tingting, Zhang, Yue, Guo, Nan, Zhao, Ping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
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.
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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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