ABSTRACT
Background
Postpartum depression (PPD) and inadequate postoperative pain management are significant concerns for patients undergoing cesarean sections (C-sections), impacting maternal well-being and recovery. PPD affects 1 in 7 mothers, contributing to emotional distress, impaired bonding, and long-term mental health consequences. Ketamine, an NMDA receptor antagonist, has emerged as a promising intervention due to its dual benefits—providing rapid antidepressant effects and effective pain relief while reducing opioid use.
This project aims to educate anesthesia providers on the evidence-based use of subanesthetic ketamine for managing PPD and postoperative pain in C-section patients. The PICO question for this project is as follows: In parturient patients undergoing elective cesarean-section surgery under general anesthesia or neuraxial anesthesia, does an educational module on subanesthetic doses of intravenous ketamine after the fetus is delivered, compared to no intravenous ketamine, increase provider knowledge and attitude in decreasing the incidence of postpartum depression, suicidal ideation, and postpartum pain scores?
Methods
The databases utilized in the search included MEDLINE (ProQuest), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed. The search keywords included ketamine, postpartum depression, cesarean section, and pain management. Exclusion criteria included systematic reviews, meta-analyses, and literature reviews. Inclusion parameters consisted of randomized controlled trials (RCTs) published within the past five years with full text in the English language. IRB was exempt from Florida International University. A 19-question pre-test will be given via Qualtrics, consisting of 6 demographic questions, 8 knowledge questions, and 5 questions on attitude to determine experience, baseline knowledge and attitude toward the practice change. This will be followed by a 10-minute educational module in video format. A post-survey mirroring the pretest will be conducted. Data will be reported utilizing descriptive statistics comparing pre and post module assessments via Qualtrics platform.
Results
Provider knowledge improved across most domains, with the average correct response rate rising from 61.88% on the pre-test to 71.88% on the post-test. Attitudes toward ketamine also shifted positively. The percentage of participants who reported being “more likely” to implement ketamine in practice increased from 0% to 28.57%, and positive attitudes rose from 43% to 71.43%. Additionally, awareness of the importance of PPD prevention improved, with participants more frequently considering it during cesarean deliveries. The findings suggest the educational module was effective in enhancing both knowledge and confidence in using ketamine as part of a multimodal strategy in obstetric anesthesia.
Discussion
PPD remains a significant concern among new mothers, affecting maternal well-being and recovery. Cesarean delivery is a significant risk factor for PPD, and effective early interventions are limited. Ketamine, an NMDA receptor antagonist, has demonstrated rapid antidepressant effects, pain relief, and opioid-sparing properties. Research supports its use in reducing PPD and suicidal ideation when administered intravenously after fetal delivery. This project introduces an educational module to improve anesthesia providers’ knowledge and attitudes regarding ketamine use in obstetric patients. Increasing provider awareness may enhance clinical decision-making and promote the use of ketamine as a pharmacologic adjunct to reduce PPD and improve postoperative pain outcomes. Limitations include lack of standardized protocols and provider familiarity, but education can bridge this gap and support safer, more effective maternal care.
Conclusion
This QI project demonstrated that a brief, focused educational intervention can meaningfully improve anesthesia provider knowledge and attitudes regarding ketamine’s role in managing PPD and postoperative pain in cesarean section patients. These findings support the integration of ketamine education into routine provider training and highlight the need for further research and protocol development in this area.
Keywords: Postpartum Depression, Ketamine, Cesarean Section, Anesthesia Education, Multimodal Analgesia, Postoperative Pain, Obstetric Anesthesia