Association of multimodal analgesic protocol with postpartum depression incidence and sleep quality in high-risk parturients

Hui Zhang; Yan An Jiang; Huajun Fu; Lin Zhang; Gang Zhang

doi:10.3389/fmed.2026.1828838

Association of multimodal analgesic protocol with postpartum depression incidence and sleep quality in high-risk parturients

Front Med (Lausanne). 2026 May 20:13:1828838. doi: 10.3389/fmed.2026.1828838. eCollection 2026.

Authors

Hui Zhang¹, Yan An Jiang¹, Huajun Fu¹, Lin Zhang¹, Gang Zhang¹

Affiliation

¹ Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.

Abstract

Background: Postpartum depression (PPD) affects 10-20% of women after childbirth, with incidence reaching 30-50% in high-risk populations. Acute postoperative pain and sleep disturbance represent modifiable risk factors. This study evaluated whether a multimodal analgesic protocol combining dexmedetomidine and esketamine is associated with reduced PPD incidence in high-risk parturients undergoing cesarean delivery.

Methods: This single-center, retrospective cohort study included 82 high-risk parturients who received intraoperative esketamine (0.25 mg/kg) followed by postoperative dexmedetomidine-esketamine patient-controlled analgesia for 48 h between January 2023 and December 2024. Historical controls (n = 79) from 2022 received standard sufentanil-based analgesia. The primary outcome was PPD incidence at 6 weeks (Edinburgh Postnatal Depression Scale >10).

Results: PPD incidence was significantly lower in the intervention group versus controls (14.6% vs. 29.1%; relative risk 0.50, 95% confidence interval 0.27-0.93; p = 0.028; number needed to treat 6.9). Edinburgh Postnatal Depression Scale (EPDS) score decreased more in the intervention group (-2.8 ± 3.4 vs. +0.6 ± 4.1; p < 0.001). Sleep quality at postoperative day 7 was better (Pittsburgh Sleep Quality Index 6.2 ± 2.8 vs. 8.9 ± 3.1; p < 0.001). Opioid consumption decreased by 21.2% (p < 0.001). Exploratory biomarker assessment in a subset suggested lower interleukin-6 and higher brain-derived neurotrophic factor (both p < 0.001), though these data were non-systematic. Psychotomimetic effects occurred in 8.5%, all transient. No significant differences in cardiovascular or respiratory adverse events were observed.

Conclusion: A multimodal analgesic protocol incorporating dexmedetomidine-esketamine multimodal analgesic protocol was associated with lower postpartum depression incidence, better sleep quality, and acceptable safety in high-risk parturients. Randomized trials are needed to establish causality.

Keywords: cesarean delivery; dexmedetomidine; esketamine; high-risk parturients; multimodal analgesia; postpartum depression; sleep quality.