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Continuous intraoperative esketamine infusion reduces the incidence of postoperative sleep disorders and improves sleep quality in parturients undergoing cesarean section under general anesthesia.

In a randomized, double-blind, placebo-controlled trial, 140 parturients undergoing elective cesarean delivery under general anesthesia received either continuous esketamine (0.3 mg/kg/h) or saline after delivery. At 3 and 7 days post-surgery, the esketamine group had significantly lower PSQI scores, lower sleep NRS scores, and lower incidence of PSD and postpartum depression compared to controls. The intervention also reduced pain scores and rescue analgesia use within 72 hours.

Last updated: Aug 20, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. 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.

observational

Chen H, An L, Zhang P, Xiao M, Wang Q · Frontiers in medicine (2026)

Participants: N/A
Duration: 7 days post-surgery
Intervention: Continuous intravenous infusion of esketamine at 0.3 mg/kg/h after delivery until end of surgery
Outcome: Postoperative sleep disorder (PSD) incidence at 3 days, PSQI score, sleep NRS score, pain NRS score, postpartum depression (EPDS), rescue analgesia use
Effect Size: N/A (odds ratios reported for risk factors: 24-h pain NRS OR=1.485, antepartum sleep disorder OR=4.757)
Population: Parturients undergoing elective cesarean section under general anesthesia

Result:

PubMed: 42602089DOI: 10.3389/fmed.2026.1837631

Mechanism Graph

Esketamine provides analgesic effects reducing postoperative pain
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Reduced pain leads to better sleep continuity and quality
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Esketamine may have antidepressant effects reducing postpartum depression
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Improved mood and pain contribute to lower PSD incidence

Limitations

  • ⚠Single-center study may limit generalizability
  • ⚠No long-term follow-up beyond 7 days post-surgery
  • ⚠Potential unblinding due to psychoactive effects of esketamine
  • ⚠Specific mechanism for sleep improvement not directly measured

Frequently Asked Questions

What is the recommended dose of esketamine for preventing sleep disorders after cesarean section?▼

The study used a continuous infusion of 0.3 mg/kg/h after delivery, which significantly reduced postoperative sleep disorder incidence.

How does esketamine improve sleep quality in postpartum women?▼

Esketamine likely improves sleep by reducing postoperative pain and depressive symptoms, which are known to interfere with sleep.

Are there any risks associated with esketamine use in cesarean section?▼

The abstract mentions evaluation of adverse reactions and maternal-neonatal complications, but specific risks are not detailed; however, esketamine is generally used under anesthesia supervision.

What are the risk factors for postoperative sleep disorder in cesarean patients?▼

The study identified a 24-hour postpartum pain NRS score (OR=1.485) and antepartum sleep disorder (OR=4.757) as significant risk factors.

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References

  1. 1.Chen H, An L, Zhang P, Xiao M, Wang Q. "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.." Frontiers in medicine, 2026. PMID: 42602089 DOI: 10.3389/fmed.2026.1837631
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.