Intravenous ketamine to prevent post-partum depression following cesarean under neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials.

Background: Postpartum depression (PPD) significantly affects well-being and the ability to function normally, making preventive strategies crucial. The role of intravenous ketamine in preventing PPD, especially after cesarean sections under neuraxial anesthesia, remains unclear and controversial.

Objectives: This systematic review and meta-analysis aimed to assess the efficacy and safety of perioperative intravenous ketamine administration in preventing postpartum depression among women undergoing cesarean section under neuraxial anesthesia.

Search strategy: A comprehensive electronic search was conducted for literature published from 2000 to January 1, 2023, in multiple databases, including PubMed/MEDLINE and the Cochrane Database of Systematic Reviews, using relevant keywords. Language restrictions were not applied.

Selection criteria: The included studies were randomized controlled trials (RCTs) that met the following criteria: adult patients (<18 years) undergoing elective cesarean section under neuraxial anesthesia, peripartum intravenous administration of ketamine, placebo as a comparison group, and postpartum depression as the primary outcome.

Data collection and analysis: Data were extracted on various parameters, including study characteristics, ketamine protocol, control group details, results, and quality assessment scores. Meta-analysis was performed using the RevMan 5.4 statistical package, and outcomes were assessed using odds ratios (ORs) for dichotomous data and mean differences (MD) for continuous data, using a random effects model.

Main results: Ten studies involving 2219 patients (1094 in the ketamine group and 1125 in the control group) were included. The meta-analysis did not show significant differences in the incidence of PPD or EPDS scores between the ketamine and control groups postoperatively. However, ketamine administration resulted in a reduction in postoperative pain scores and total opioid consumption but increased the incidence of headaches.

Conclusion: Perioperative intravenous administration of ketamine does not have a prophylactic effect on postpartum depression in patients undergoing cesarean section under neuraxial anesthesia but does reduce postoperative pain and total opioid consumption. The increased incidence of side effects, such as headaches, dizziness, and drowsiness, warrants further investigation. Additional large RCTs are necessary to further explore ketamine's potential prophylactic effect on PPD.