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已发表论文
低剂量艾司氯胺酮联合右美托咪定用于剖宫产术后自控静脉镇痛可改善睡眠质量：一项双盲随机对照试验
Authors Zhang L, He Y, Chen L, Liu X, Zhang T, Zhou X, Mao W, Zhao L, Li L, Xie Y
Received 26 July 2025
Accepted for publication 23 October 2025
Published 4 November 2025 Volume 2025:19 Pages 9789—9796
DOI https://doi.org/10.2147/DDDT.S556396
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Anastasios Lymperopoulos
Longyi Zhang,* Yunzi He,* Linlin Chen, Xianchun Liu, Ting Zhang, Xuelei Zhou, Wei Mao, Li Zhao, Linji Li, Ying Xie
Department of Anesthesiology, Beijing Anzhen Nanchong Hospital (Nanchong Central Hospital), The Second Clinical Medical College, North Sichuan Medical College, Nanchong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ying Xie, Department of Anesthesiology, Beijing Anzhen Nanchong Hospital (Nanchong Central Hospital), The Second Clinical Medical College, North Sichuan Medical College, Nanchong, People’s Republic of China, Email xying1025@163.com
Purpose: Postoperative sleep disturbance can hinder recovery after cesarean section. Although either esketamine or dexmedetomidine alone has been shown to improve sleep quality, their combined use in patient-controlled intravenous analgesia (PCIA) has not been well studied. This study aimed to evaluate whether adding dexmedetomidine to esketamine in PCIA could further enhance postoperative sleep quality in women after cesarean delivery.
Patients and Methods: In this randomized trial, 105 women receiving PCIA were assigned to control (C), esketamine (E), or esketamine-dexmedetomidine (ED) groups. The primary outcome was the Richards-Campbell Sleep Questionnaire (RCSQ) score on postoperative day 1 (POD1). Secondary outcomes included pain Numerical Rating Scale (NRS) scores, Ramsay sedation scores, RCSQ on POD2– 3, Hospital Anxiety and Depression Scale (HADS) scores, analgesic demands, and adverse events.
Results: On POD1, the RCSQ scores were significantly higher in both the Group E (43.5 ± 17.2; mean difference = 11.6; 95% CI, 4.8– 18.6; P = 0.008) and the Group ED (52.6 ± 11.5; mean difference = 20.7; 95% CI, 13.9– 27.6; P < 0.001) compared with the Group C (31.9 ± 14.2). The Group ED also showed a greater improvement in sleep quality than the Group E (mean difference = 9.1; 95% CI, 2.2– 15.9; P = 0.032). Both intervention groups had lower resting NRS scores and fewer PCIA demands than the control group. No significant differences were found among the three groups regarding adverse events or other secondary outcomes.
Conclusion: Low-dose esketamine combined with dexmedetomidine in PCIA effectively improved postoperative sleep quality and pain relief after cesarean section, proving to be a safe and effective analgesic adjunct.
Keywords: esketamine, cesarean section, patient-controlled intravenous analgesia, dexmedetomidine, sleep quality
Department of Anesthesiology, Beijing Anzhen Nanchong Hospital (Nanchong Central Hospital), The Second Clinical Medical College, North Sichuan Medical College, Nanchong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ying Xie, Department of Anesthesiology, Beijing Anzhen Nanchong Hospital (Nanchong Central Hospital), The Second Clinical Medical College, North Sichuan Medical College, Nanchong, People’s Republic of China, Email xying1025@163.com
Purpose: Postoperative sleep disturbance can hinder recovery after cesarean section. Although either esketamine or dexmedetomidine alone has been shown to improve sleep quality, their combined use in patient-controlled intravenous analgesia (PCIA) has not been well studied. This study aimed to evaluate whether adding dexmedetomidine to esketamine in PCIA could further enhance postoperative sleep quality in women after cesarean delivery.
Patients and Methods: In this randomized trial, 105 women receiving PCIA were assigned to control (C), esketamine (E), or esketamine-dexmedetomidine (ED) groups. The primary outcome was the Richards-Campbell Sleep Questionnaire (RCSQ) score on postoperative day 1 (POD1). Secondary outcomes included pain Numerical Rating Scale (NRS) scores, Ramsay sedation scores, RCSQ on POD2– 3, Hospital Anxiety and Depression Scale (HADS) scores, analgesic demands, and adverse events.
Results: On POD1, the RCSQ scores were significantly higher in both the Group E (43.5 ± 17.2; mean difference = 11.6; 95% CI, 4.8– 18.6; P = 0.008) and the Group ED (52.6 ± 11.5; mean difference = 20.7; 95% CI, 13.9– 27.6; P < 0.001) compared with the Group C (31.9 ± 14.2). The Group ED also showed a greater improvement in sleep quality than the Group E (mean difference = 9.1; 95% CI, 2.2– 15.9; P = 0.032). Both intervention groups had lower resting NRS scores and fewer PCIA demands than the control group. No significant differences were found among the three groups regarding adverse events or other secondary outcomes.
Conclusion: Low-dose esketamine combined with dexmedetomidine in PCIA effectively improved postoperative sleep quality and pain relief after cesarean section, proving to be a safe and effective analgesic adjunct.
Keywords: esketamine, cesarean section, patient-controlled intravenous analgesia, dexmedetomidine, sleep quality