Esketamine Prevent Carboprost-Induced Adverse Reactions During Cesarean Section Under Combined Spinal-Epidural Anesthesia: a double-blind, randomized trial

Objectives To investigate reduce adverse reactions to carboprost of intravenous esketamine administered after childbirth via cesarean delivery with the patient under combined spinal-epidural anesthesia. Methods The study involved women within the age bracket of 20 and 40 years, with American Society of Anesthesiologists (ASA) class II or III, and a gestational age of 37 weeks or more. These women had a scheduled cesarean section procedure with the administration of combined spinal-epidural anesthesia. Patients were randomized to receive esketamine 0.5 mg/kg (Group E) or volume-matched normal saline (Group C) after delivery of the fetus, before carboprost administered. The primary outcome was the incidence of vomiting during surgery. The secondary outcomes were the incidence of adverse reactions (vomiting, nausea, chest rigidity, flushed face, tachycardia, cough, shivering), vital signs (HR, RR, MAP, SPO ₂ ) and blood gas analysis of intraoperative, as well as VAS score for postoperative pain. Results Eighty-one pregnancy women completed the study. The incidence of vomiting (22.5% versus 56.1%, p < 0.001) and the incidence of nausea, chest rigidity, flushed face, and hypertension were significantly lower in group E than in group C (all p < 0.01), but the incidence of tachycardia was higher in group E (45% vs 19.5%, p < 0.001). Furthermore, the patients’ arterial partial pressure of oxygen was significantly higher in group E than in group C (91.90 ± 5.14 vs. 79.76 ± 3.96, p < 0.001). Significant reduction in VAS-incision pain scores 6 hours after surgery in group E, but no significant difference was found at the VAS-uterine pain scores. Conclusion For women undergoing cesarean delivery under combined spinal-epidural anesthesia, intravenous esketamine after delivery of the fetus, before carboprost administered not only reduced the incidence of adverse reactions caused by carboprost, but also relieve postoperative uterine contractions pain. Trial registration: Chinese Clinical Trial Registry (Registration number# ChiCTR2100054985); Date of Registration: 30/12/2021