Objective To investigate the effect of esketamine combined with ropivacaine in patients with cesarean section undergoing patient-controlled epidural analgesia (PCEA).

Methods A total of 76 full-term pregnant women who delivered cesarean section under combined lumbo-epidural anesthesia were selected, and randomly divided into group K (esketamine) and group C (control), with 38 cases in each group. Group K was given analgesic pump formula (esketamine 50 mg+ ropivacaine 200 mg), group C was given analgesic pump formula (ropivacaine 200 mg). Numerical pain scores (NRS) at rest and activity (hip flexion) were observed in two groups at 6, 12, 24, 36 and 48 h after surgery. The 40-item Recovery Quality Scale (QoR-40) scores was compared between the two groups. The occurrence of postoperative adverse reactions was compared between the two groups.

Results The NRS scores of the group K were significantly lower than that of the group C at rest 24, 36 and 48 hours after operation (P < 0.05); the NRS scores of the group K were significantly lower than that of the group C at 12, 24, 36 and 48 h after operation (P < 0.05). The QoR-40 scores of the group K were significantly higher than that of the group C at 1 day and 2 days after operation (P < 0.05). The incidence of postoperative chills, nausea and vomiting in the group K was significantly lower than that in the group C (P < 0.05).

Conclusion Esketamine combined with ropivacaine for PCEA after cesarean section can optimize analgesic effect, reduce adverse reactions and improve recovery quality.