Prospective case-control observational study (n=150) comparing single-dose IV ketamine (0.5 mg/kg), ketamine plus midazolam, and saline placebo in patients undergoing caesarean section to evaluate postpartum depression and postoperative outcomes.
This prospective case-control study will allocate 150 patients undergoing caesarean section under spinal anaesthesia into three groups: ketamine 0.5 mg/kg IV, midazolam pre-dose followed by ketamine 0.5 mg/kg IV, or 5 ml IV saline placebo.
Postpartum depression will be assessed with the Edinburgh Postpartum Depression Scale (EPDS) preoperatively and at 1, 2 and 4 weeks post partum; secondary outcomes include analgesic requirement and adverse effects such as dizziness, hallucinations, nausea and vomiting.
Single IV bolus ketamine 0.5 mg/kg (diluted to 5 ml) given after cord clamping.
Diluted to 5 ml; given within 5 minutes after cord clamping.
Single IV midazolam pre-dose followed by ketamine 0.5 mg/kg (diluted to 5 ml) after cord clamping.
Midazolam given prior to ketamine (arm text lists 0.0125 mg/kg; another section lists 0.03 mg/kg — see laterInfo).
Diluted to 5 ml; given after midazolam and after cord clamping.
5 ml IV physiological saline single dose.
5 ml normal saline (placebo) given after cord clamping.