The objective of this study is evaluate the breastmilk transfer and pharmacokinetics (Part 1) and effectiveness (Part 2) of a post-cesarean delivery intravenous ketamine bolus-and-infusion strategy, as a preventive analgesic modality to reduce pain and opioid requirements. In Part 1, physiochemical analysis of pharmacokinetic/pharmacodynamic (PK/PD) and breastmilk transfer of ketamine and its metabolites will be assessed. Additionally calculated estimations for neonatal and infant exposure will be assessed. In Part 2, PK/PD assessments will continue in a larger cohort; endpoints will also include postpartum pain, depression scores, central sensitization measures, patient-reported postpartum recovery scores, breastfeeding, and parent-infant bonding, assessed in the acute post-cesarean period and up to 12 weeks postpartum in a randomized controlled trial.
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Ketamine (AUC)
Timeframe: 12 hour ketamine infusion
Steady State (Css)
Timeframe: 12 hours after ketamine infusion start
Elimination Half Life (T1/2) for Ketamine
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Volume of Distribution Steady State (Vdss)
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Ketamine Milk to Plasma Ratio (M:P)
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Nor-ketamine Milk to Plasma Ratio
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Hydroxynorketamine M:P Ratio
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Relative Infant Dose of Ketamine (RID KET)
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population
Relative Infant Dose of Ketamine Equivalent (Ketamine, Norketamine, Dehydro-norketamine)
Timeframe: 27 hours postpartum or 24 hour CTRC appointment for weaning population