Objective To evaluate the effect of esketamine for cesarean section under epidural an-esthesia and maternal and fetal outcome.Methods The parturients all were singleton pregnancies at term and scheduled for elective cesarean delivery.Ninety parturients undergoing elective cesarean delivery under epidural anesthesia,aged 20-40 years,BMI 18-35 kg/m2,ASA physical status Ⅱ,were randomly alloca-ted into two groups:esketamine group(group K)and control group(group C),45 cases in each group.When the targeted upper sensory block level was achieved,esketamine 0.15 mg/kg was administered intra-venously for 1 minute before skin incision in group K,the same volume of normal saline was intravenously injected in group C.Visceral traction reaction during the operation was recorded.Apgar score was assessed 1 minute and 5 minutes after birth.The pH value,partial pressure of carbon dioxide,oxygen partial pressure,and lactic acid value of the neonatal umbilical vein blood were recorded.Adverse events such as nausea,vomiting,hallucination,dizziness and nightmare were monitored in the two groups.Results Compared with group C,visceral traction reaction was significantly lower in group K(P＜0.05).The neonatal Apgar score,pH value,carbon dioxide partial pressure,oxygen partial pressure,and lactic acid value of the neo-natal umbilical vein blood did not differ between the two groups.There were no differences in the incidence of nausea,vomiting and dizziness between the two groups.Hallucinations and nightmares were not encoun-tered in either group.Conclusion Esketamine 0.15 mg/kg can effectively reduce visceral traction reaction during cesarean delivery under epidural anesthesia.There was no significant effect on neonatal Apgar score and blood gas analysis,with no noticeable maternal and neonatal adverse effect.