The effect of esketamine on sleep disorders in parturients undergoing cesarean section under general anesthesia: a single-center, randomized, double-blind, placebo-controlled prospective study
In brief
Esketamine reduces 3-day postoperative sleep disorder incidence after cesarean under general anesthesia
In a double-blind trial of 140 women, continuous intraoperative esketamine infusion lowered the rate of sleep disturbance three days after surgery and improved sleep quality scores, while also decreasing pain scores, rescue analgesia use, and postpartum depression rates. The benefit was independent of lower propofol and remifentanil use, but prenatal sleep problems remain a key risk factor.
- Journal
- Frontiers in medicine (Q1)
- Published
- 31 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Hongzhuan Chen, Li An, Pengcheng Zhang, Maoxin Xiao, Qiwei Wang
- PMID
- 42602089
- DOI
- 10.3389/fmed.2026.1837631
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 16 August 2026): Esketamine effect on sleep disorders after cesarean under GA
- Picked for Neonatology (top studies of the week, 16 August 2026): Maternal anesthesia trial, not neonatal
Abstract
BACKGROUND: This study evaluated the primary effect of esketamine on postoperative sleep disorder (PSD) at 3 days after surgery, as well as its secondary effects on pain and depressive symptoms. METHODS: A total of 140 parturients who underwent elective cesarean delivery under general anesthesia were enrolled and randomized 1:1 to the esketamine or placebo group. After delivery, blinded anaesthesiologists administered a continuous infusion of esketamine (0.3 mg/kg/h) or an equal volume of normal saline. We compared baseline data, anesthesia/surgery indicators, postoperative PSQI scores, sleep NRS scores, incidences of PSD, pain NRS scores and postpartum depression (EPDS) between the groups. We also evaluated adverse reactions and maternal-neonatal complications and performed multivariate logistic regression for PSD risk factors. RESULTS: At 3 and 7 days after surgery, the PSQI scores, NRS scores, incidence of PSD, and incidence of postpartum depression in the esketamine group were significantly lower than those in the control group (P < 0.05). The pain NRS scores at 24, 48, and 72 h postpartum and the rate of rescue analgesia within 72 h were also significantly lower in the esketamine group (P < 0.05). Intraoperative consumption of propofol and remifentanil was significantly lower in the esketamine group than in the control group (P = 0.038 and P < 0.001, respectively). Logistic regression revealed that a 24-h postpartum pain NRS score (OR = 1.485, 95% CI: 1.058-2.084, P = 0.022) and antepartum sleep disorder (OR = 4.757, 95% CI: 2.241-10.098, P < 0.001) were risk factors for PSD in parturients who underwent cesarean delivery under general anesthesia. CONCLUSION: Continuous intraoperative esketamine infusion reduced the incidence of 3-day postoperative sleep disorders and improves sleep quality, while concurrently enhancing analgesic efficacy and ameliorating postpartum depression outcomes in parturients undergoing cesarean section under general anesthesia. Clinicians should prioritize screening for prenatal sleep disturbances and implement early preventive interventions. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/, Identifier [ChiCTR23000 78490].
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.