Esketamine may provide pain relief during C-section without neonatal depression: JAMA

China: A new trial published in JAMA Network Open has found that a subanesthetic dose of esketamine, administered before cesarean delivery, can provide temporary pain relief and sedation without significant neonatal depression.

Although epidural anesthetic is the preferred method for cesarean delivery, additional analgesics are frequently required to ease pain during uterine traction. The purpose of this trial was to look at the sedative and analgesic effects of intravenous esketamine given before childbirth through cesarean delivery while the patient was under epidural anesthesia.

The study was multicenter, double-blind, randomized clinical trial, that involved 903 women, 18 years and older, who were scheduled for elective cesarean delivery with epidural anesthesia in five medical centers in China.

The patients were given an intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. The study's primary outcomes included scores on the numeric rating scale of pain and the Ramsay Sedation Scale immediately after fetal delivery. The secondary outcome was neonatal Apgar score assessed at 1 and 5 minutes after birth.

The study concluded with the following clinical findings:

1. Esketamine resulted in lower pain scores compared to placebo after childbirth, but the difference was not clinically significant.

2. The Ramsay sedation scores were higher with esketamine than with placebo.

3. There was no significant difference in neonatal Apgar scores between the two groups.

4. Transient neurologic or mental symptoms were more common with esketamine than with placebo.

The study concluded that indications and the optimal dose of esketamine in this patient population need further clarification, but the study should be limited to those who require supplemental analgesia.

Dr. Li-Li Xu, the lead author of the study added that “Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. This new research could provide an alternative option for pain management during cesarean delivery, especially for patients who require supplemental analgesia.”

Reference:

Xu L, Wang C, Deng C, et al. Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(4):e239321.

doi:10.1001/jamanetworkopen.2023.932