Evaluation of the effects of low-dose ketamine on postoperative pain and postpartum depression in cesarean sections under spinal anesthesia

Objective: This study aimed to evaluate the effects of low-dose ketamine and ketamine-midazolam combination on postoperative pain, postpartum depression incidence, and intraoperative side effects in patients undergoing cesarean delivery under spinal anesthesia. Materials and Methods: This prospective observational study included 300 patients who underwent cesarean section under spinal anesthesia. Patients were divided into three groups according to their intraoperative pain and anxiety status: Ketamine group (n=100, 0.5 mg/kg iv ketamine), Ketamine-Midazolam group (n=100, 0.5 mg/kg iv ketamine + 0.01 mg/kg iv midazolam), and Placebo group (n=100). Postoperative pain was assessed using the Visual Analog Scale at 2, 4, 12, and 24 hours; postpartum depression was evaluated using the Edinburgh Postnatal Depression Scale preoperatively and at 1, 2, and 4 weeks. Results: Postoperative Visual Analog Scale scores were significantly lower in the ketamine and ketamine-midazolam groups compared to the placebo group (p<0.001). Time to first analgesic requirement was longer in the ketamine and ketamine-midazolam groups compared to the placebo group (median 115-115.5 min vs 95 min, p<0.001). At postoperative week 4, the incidence of postpartum depression was 15% in the ketamine group, 17% in the ketamine-midazolam group, and 30% in the placebo group, with the ketamine group showing a statistically significantly lower incidence of postpartum depression compared to the placebo group (p=0.017). Hallucinations, nausea, and vomiting were more frequent in the ketamine group; the addition of midazolam showed a tendency to reduce these side effects. Conclusion: Low-dose ketamine is an effective adjuvant for postoperative pain control following cesarean section and reduces postpartum depression incidence. Ketamine-midazolam combination offers similar efficacy with a lower side effect profile. Keywords: Cesarean section, ketamine, midazolam, postoperative pain, postpartum depression, spinal anesthesia