Effects of epidural esketamine versus sufentanil on labor analgesia and postpartum depression: a retrospective cohort study

Objective: There is a lack of research on epidural esketamine for labor analgesia. The purpose of this research is to compare the efficacy of epidural esketamine and sufentanil on labor analgesia and postpartum depression.

Methods: A total of 187 cephalic full-term parturients with single-fetus vaginal delivery were collected in this retrospective study from Jan 2022 to Jan 2023. Parturients were categorized into two groups according to anesthetics: the esketamine group (Group KR, n = 97) with patient-controlled epidural analgesia with 0.3 mg/ml esketamine and 0.083% ropivacaine in 240 ml of normal saline and the Sufentanil group (Group SR, n = 90) with 0.3 µg/ml sufentanil and 0.083% ropivacaine in 240 ml of normal saline. The Visual Analogue Scale, Ramsay Sedation Scale, and Modified Bromage Score were recorded before, 5, 10, and 30 min after analgesia, when the uterine orifice was fully opened, and after delivery. The Edinburgh Postnatal Depression Scale(EPDS) scores at 3 and 42 days after delivery were recorded. The maternal and infant outcomes and occurrence of maternal adverse reactions were recorded.

Results: The VAS scores after analgesia at 5,10,30 min and when the cervix was fully opened were higher in Group KR than Group SR (all P < 0.05). RSS scores at 5,10,30 min after analgesia in group KR were lower in Group KR than Group SR (all P < 0.05). Compared with group SR, significant decreases were shown in the EPDS and the incidence of postpartum depression at 42 days after delivery in Group KR (all P < 0.05). Group KR has considerably decreased rates of pruritus compared to Group SR (P < 0.05). The other adverse effects showed no significant difference (all P > 0.05). The maternal and neonatal outcomes were not significantly different between the two groups (all P > 0.05).

Conclusions: In comparison to sufentanil, epidural esketamine for labor analgesia may exhibit a better sedative effect, and a low incidence of pruritus, but a limited analgesic effect. It may be associated with a lower risk of postpartum depression. Further exploration of the optimal regimen and dosage of esketamine for epidural labor analgesia would be necessary.