Low-Dose Esketamine Plus Dexmedetomidine in Patient-Controlled Intravenous Analgesia Improves Post-Cesarean Sleep Quality: A Double-Blind Randomized Trial.

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.