A Patient-Controlled Intravenous Analgesia With Tramadol Ameliorates Postpartum Depression in High-Risk Woman After Cesarean Section: A Randomized Controlled Trial

Frontiers in Medicine

article

Zhuoxi Wu¹  Yang Li¹  Zhengqiong Chen²  Qingling Zhang³  Qiangting Deng⁴  Guangyou Duan¹  Zhiyi Zuo⁵  Hong Li¹  Peng Zhao¹  Jing Peng¹  Liang Fang¹  Jinping Ding¹  Guangming Yan¹  Yang Wang¹  Jing Zhu¹  Dongting Wang¹ 

[1] Department of Anesthesiology, Second Affiliated Hospital of Army Medical University;Department of Obstetrics, Second Affiliated Hospital of Army Medical University;Department of Psychology, Second Affiliated Hospital of Army Medical University;Editorial Office of Journal of Third Military Medical University, Army Medical University;Department of Anesthesiology, University of Virginia, United States;Department of Anesthesiology, Chinese People's Liberation Army of China (PLA) No. 964 Hospital

关键词: tramadol;    postpartum depression;    cesarean section;    PCIA;    perioperative period tramadol PCIA ameliorates PPD 2;   

DOI  :  10.3389/fmed.2021.679159

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Postpartum depression (PPD) is a severe psychiatric disorder. Its risk is associated with the cesarean section (CS). Currently, there are few early intervention strategies for these women with PPD who underwent CS. Methods: This was a parallel-group randomized controlled trial of singleton pregnant women who underwent elective CS in a tertiary referral hospital in China from October, 2017 to September, 2019. After operation, patients received randomly tramadol patient-controlled intravenous analgesia (PCIA; 4 mg/ml; TRA group), hydromorphone PCIA (0.04 mg/ml; HYD group), or ropivacaine patient-controlled epidural analgesia (PCEA; 1.5 mg/ml; ROP group) for 48 h in a 1:1:1 ratio. Total blinding during hospitalization was not feasible due to differences between the PCEA and PCIA treatments. All investigators who performed the follow-up were blinded to the group assignment. Outcomes: A total of 1,230 patients were enrolled for eligibility. Intention-to-treat analysis showed reduced incidence of PPD in the TRA group ( n = 27 [6.6%]) than that in the HYD (10.2%, OR 1.62, 95% CI 0.98~2.68; p = 0.059) and ROP groups (10.5%, OR 1.66, 95% CI 1.01~2.75; p = 0.046) at 4 weeks post-operation, however, the difference was not statistically significant (Bonferroni corrected p = 0.118, p = 0.098, respectively). Subgroup analysis in high-risk women (preoperative Edinburgh Postpartum Depression Scale [EPDS] ≥10) showed a significantly lower incidence of PPD in the TRA group (16.5%) than in the HYD (32.6%) and ROP groups (30.9%) (Bonferroni corrected p = 0.022 and p = 0.038, respectively). The per-protocol analysis yielded similar results. Reported adverse events (AEs) were mostly mild. None of the women or infant discontinued treatment due to AEs. Conclusions: Tramadol PCIA after CS in high-risk women can help to reduce the risk of PPD at 4 weeks after elective CS. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT03309163","term_id":"NCT03309163"}} NCT03309163 ?term=ETPPD&draw=2&rank=1; ClinicalTrials.gov ( {"type":"clinical-trial","attrs":{"text":"NCT03309163","term_id":"NCT03309163"}} NCT03309163 ).

【 授权许可】

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