An editorial comments on a study by Chen et al. about intraoperative esketamine for pain and recovery after cesarean section. Poorly managed post-cesarean pain can reduce maternal care for the baby, lengthen hospital stays, and increase the risk of postpartum depression. Esketamine, a potent form of ketamine, shows promise for pain relief and antidepressant effects in clinical studies. However, due to potential neurological and hemodynamic side effects, low-dose use should be limited to candidates with unbearable pain. More standardized trials are needed before routine perioperative use can be recommended.
Emergency cesarean section is linked to postpartum depression. While esketamine shows rapid antidepressant effects, and trials support its use to prevent postpartum depression after elective cesarean sections, the evidence does not cover emergency procedures. Esketamine carries a dose-dependent risk of psychotic symptoms like hallucinations, so it should be used cautiously in cesarean settings only when benefits outweigh risks.