Effects of hydromorphone-based patient-controlled intravenous analgesia on postpartum depression after cesarean section: a prospective randomized controlled trial

Background Postpartum depression (PPD) is a common mental health condition affecting 10–20% of women, particularly after cesarean delivery, which may hinder maternal recovery and breastfeeding. Hydromorphone, a semi-synthetic opioid with unique pharmacologic properties, has recently been applied in postoperative analgesia. This study aimed to evaluate the effects of hydromorphone-based patient-controlled intravenous analgesia (PCIA) on PPD and related maternal–infant outcomes after cesarean section. Methods In this prospective, randomized, double-blind controlled trial, 120 parturients aged 20–40 years scheduled for elective cesarean section were randomly assigned to receive either sufentanil (Group S, n = 60, 2 μg/kg) or hydromorphone (Group H, n = 60, 0.2 mg/kg) for PCIA. A computer-generated block randomization sequence was used, and allocation concealment was ensured through a centralized randomization system. Both regimens included palonosetron (4 μg/kg) diluted with saline to 150 mL and identical pump settings. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) score on postoperative day 42. Secondary outcomes included EPDS score on day 3, breastfeeding satisfaction at 72 h, Ramsay sedation scores at 24 and 48 h, resting and active Numeric Rating Scale (NRS) pain scores at 2, 6, 12, 24, and 48 h, rescue analgesia requirements, and adverse events within 48 h after surgery. Results Compared with Group S, Group H had significantly lower EPDS scores on postoperative days 3 and 42, higher breastfeeding satisfaction at 72 h, and lower Ramsay sedation scores at 24 and 48 h (all p < 0.01). Resting and active NRS pain scores at 6 and 12 h were also reduced ( p < 0.05). The incidence of dizziness and drowsiness within 48 h was significantly lower in Group H ( p < 0.05). No significant differences were observed between the two groups in rescue analgesia requirements or other adverse events. Conclusion Hydromorphone-based PCIA after cesarean section was associated with lower EPDS scores on postoperative days 3 and 42, improved breastfeeding satisfaction at 72 h, and a lower incidence of dizziness and drowsiness. Clinical trial registration www.chictr.org.cn , identifier ChiCTR2500105264.