Palabras clave
Anestesia obstétrica
Ketamina
Esketamina
Cómo citar
Copyright © | Todos los derechos reservados.
La revista posee los derechos de autor exclusivos para la publicación de este artículo en los términos de la ley brasileña 9610/98.
Reproducción parcial
El uso de partes de los textos, figuras y cuestionario del artículo es libre, siendo obligatoria la citación de los autores y revista.
Reproducción total
Está expresamente prohibido y debe ser autorizado por la revista.
Resumen
Objetivo: Analizar el impacto de la analgesia neuraxial y la administración perioperatoria de ketamina o esketamina en la incidencia y gravedad de la DPP. Métodos: Se trata de una revisión integradora realizada en las bases de datos PubMed/MEDLINE y BVS, incluyendo ensayos clínicos y revisiones sistemáticas publicados entre 2020 y 2025 en portugués e inglés. La muestra final incluyó 11 estudios. Resultados: La esketamina demostró mayor eficacia que la ketamina racémica, reduciendo el riesgo de DPP en un 57% a corto plazo. Sus mecanismos incluyen antagonismo NMDA, aumento del BDNF y efectos antiinflamatorios. La analgesia neuraxial presentó resultados heterogéneos, sin protección universal, aunque con beneficios en nulíparas y poblaciones asiáticas. Consideraciones finales: La esketamina se muestra prometedora como profilaxis a corto plazo, mientras que la analgesia neuraxial no debe utilizarse como estrategia aislada para la prevención de la DPP.
Referencias
ALIPOOR M, et al. The effect of ketamine on preventing postpartum depression. Journal of Medicine and Life, 2021; 14(1): 87-92.
ALMEIDA M, et al. The association between labor epidural analgesia and postpartum depression: a systematic review and meta-analysis. BMC Women’s Health, 2020; 20: 99.
BHATIA M, et al. Maternal Total β-Endorphin Immunoreactivity During Labor and Delivery. Journal of Maternal-Fetal Investigation, 1993; 3(2): 95-99.
CHEN Y, et al. Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery: A Randomized Clinical Trial. JAMA Network Open, 2024; 7(3): e240953.
DARWISH MY, et al. Efficacy and safety of ketamine and esketamine in reducing the incidence of postpartum depression: an updated systematic review and meta-analysis. BMC Pregnancy and Childbirth, 2025; 25: 125.
DU W, et al. Labor pain, labor epidural analgesia, and postpartum depression: recent evidence and future directions. Journal of Pain Research, 2022; 15: 3007-3015.
DU W, et al. The role of anesthesiologists in postpartum depression: current perspectives and future directions. Frontiers in Psychiatry, 2025; 16: 1511817.
GUGLIELMINOTTI J, LI G. Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization. Anesthesia & Analgesia, 2020; 131(5): 1421-1429.
KOUNTANIS J, et al. Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies. Journal of Clinical Anesthesia, 2020; 61: 109658.
LI B, et al. Neuraxial analgesia during labor and postpartum depression: Systematic review and meta-analysis. Medicine, 2023; 102(8): e33039.
LI S, et al. Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis. Journal of Affective Disorders, 2024; 351: 720-728.
ORBACH-ZINGER S, et al. A systematic review of the association between postpartum depression and neuraxial labor analgesia. International Journal of Obstetric Anesthesia, 2020; 45: 142-149.
PAYNE JL e MAGUIRE J. Pathophysiological mechanisms implicated in postpartum depression. Frontiers in Neuroendocrinology, 2019; 52: 165-180.
REN L, et al. Intraoperative Esketamine and Postpartum Depression Among Women With Cesarean Delivery: A Randomized Clinical Trial. JAMA Network Open, 2025; 8(2): e2459331.
RIAZANOVA OV, et al. Labor pain relief and postpartum depression. Is there any correlation? Journal of Obstetrics and Women’s Diseases, 2017; 66(5): 11-20.
ROBINSON KA, et al. A Quasi-Experimental Study: Social Support in Group Prenatal Care Impact on Postpartum Depression in Black and Hispanic Women. International Journal of Environmental Research and Public Health, 2025; 22(7): 1046.
SPROUSE-BLUM AS, et al. Understanding endorphins and their importance in pain management. Hawaii Medical Journal, 2010; 69(3): 70-71.
TAN DJ, et al. Epidural analgesia and postpartum depression: a randomised controlled trial. Anaesthesia, 2024; 79(8): 836-843.
TONG S, et al. Obstetric anesthesia clinic, childbirth course combined with labor epidural analgesia is associated with a reduced risk of postpartum depression: A prospective cohort study. BMC Anesthesiology, 2022; 22(1): 389.
WANG J, et al. Association between neuraxial labor analgesia and postpartum depression: A meta-analysis. Journal of Affective Disorders, 2022; 311: 95-102.
WANG S, et al. Single low-dose ketamine infusion for women with prenatal depressive symptoms undergoing cesarean delivery: a pilot randomized trial. Frontiers in Surgery, 2022; 9: 1050232.
WANG W, et al. Effect of esketamine on postpartum depression after labor analgesia and potential mechanisms: a randomized, double-blinded controlled trial. BMC Anesthesiology, 2024; 24(4): 4.
YIM IS, et al. Biological and Psychosocial Predictors of Postpartum Depression: Systematic Review and Call for Integration. Annual Review of Clinical Psychology, 2015; 11: 99-137.
YIM IS, et al. Prenatal beta-endorphin as an early predictor of postpartum depressive symptoms in euthymic women. Journal of Affective Disorders, 2010; 125(1-3): 360-365.