Ketamine Tolerated Dose for Postpartum Depression and Pain After Cesarean Delivery (PREPARE 1)

NCT ID: NCT05907213

Last Updated: 2025-09-12

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-25

Study Completion Date

2024-09-19

Brief Summary

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The purpose of this study is to identify a tolerable dose for postpartum ketamine infusion using a maximum tolerated dose (MTD) 3+3 design. A loading dose over 1 hour will be the MTD variable to be tested, as our data suggest that ketamine side effects occur with the loading dose. The investigators hypothesize that subanesthetic ketamine dose will be well tolerated and any noted side effects will be rated acceptable by postpartum women following cesarean delivery.

Detailed Description

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Pain management for women having a cesarean delivery is rather limited and risks poor pain control, depressed mood, and poor recovery following the cesarean delivery. Current cesarean pain management treatments ignore the multidimensionality of pain, including the influence of mood on pain. Recent evidence suggests that ketamine may provide successful post-surgical pain management, opioid reduction, and rapid reduction of depressive symptoms. The current study aims to identify an appropriate dose of ketamine for post-cesarean pain management while minimizing potential dose-dependent side effects in women following childbirth.

Conditions

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Pain, Postoperative Depression, Postpartum

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

MTD 3+3 design
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Ketamine (Ketalar) Dose Level 1

Ketamine (Ketalar) Dose Level 1: Loading Dose: 0.05 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Group Type EXPERIMENTAL

Ketamine (Ketalar) Dose Level 1

Intervention Type DRUG

Loading Dose: 0.05 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Ketamine (Ketalar) Dose Level 2

Ketamine (Ketalar) Dose Level 2: Loading Dose: 0.08 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Group Type EXPERIMENTAL

Ketamine (Ketalar) Dose Level 2

Intervention Type DRUG

Loading Dose: 0.08 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Ketamine (Ketalar) Dose Level 3

Ketamine (Ketalar) Dose Level 3: Loading Dose: 0.12 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Group Type EXPERIMENTAL

Ketamine (Ketalar) Dose Level 3

Intervention Type DRUG

Loading Dose: 0.12 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Ketamine (Ketalar) Dose Level 4

Ketamine (Ketalar) Dose Level 4: Loading Dose: 0.18 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Group Type EXPERIMENTAL

Ketamine (Ketalar) Dose Level 4

Intervention Type DRUG

Loading Dose: 0.18 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Interventions

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Ketamine (Ketalar) Dose Level 1

Loading Dose: 0.05 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Intervention Type DRUG

Ketamine (Ketalar) Dose Level 2

Loading Dose: 0.08 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Intervention Type DRUG

Ketamine (Ketalar) Dose Level 3

Loading Dose: 0.12 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Intervention Type DRUG

Ketamine (Ketalar) Dose Level 4

Loading Dose: 0.18 mg/kg/hr X 1 hour; Maintenance Dose 0.05 mg/kg/hr x 12 hours

Intervention Type DRUG

Other Intervention Names

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0.05 mg/kg/1hr loading dose Ketamine 0.08 mg/kg/1hr loading dose Ketamine 0.12 mg/kg/1hr loading dose Ketamine 0.18 mg/kg/1hr loading dose Ketamine

Eligibility Criteria

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Inclusion Criteria

* Adults 18 years and older
* Cesarean Delivery
* American Society of Anesthesiologists Physical Status of 2 or 3
* Neuraxial anesthesia with neuraxial morphine
* Term delivery ≥37 weeks gestation
* Either planning not to breastfeed, OR receiving ketamine as part of routine clinical care

Exclusion Criteria

* General anesthesia
* Allergy to study medications
* ASA PS 4 or higher
* Contraindications to neuraxial anesthesia
* Preterm delivery (\<37 weeks gestation)
* Anticipated fetal-neonatal complex care plan
* Participating in another pain intervention trial
* Hypertensive disorder of pregnancy
* Pre-eclampsia with severe features
* Hemodynamic instability
* Medical History exclusions: ketamine or PCP (phencyclidine) abuse, schizophrenia or psychosis, liver or renal insufficiency, uncontrolled hypertension, chest pain, arrhythmia, head trauma, or intracranial hypertension, uncontrolled thyroid disease, or other contraindications to ketamine
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

Grace Lim, MD, MS

OTHER

Sponsor Role lead

Responsible Party

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Grace Lim, MD, MS

Associate Professor, Chief Obstetric & Women's Anesthesiology

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Grace Lim, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Magee Womens Hospital of UPMC

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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R01MH134538

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY22100018

Identifier Type: -

Identifier Source: org_study_id

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