Abstract： Objective To investigate the effects of esketamine on postpartum recovery,depression and sleep quality in obese pregnant women with cesarean delivery of second or third child.Methods A total of 86 obese pregnant women who had cesarean delivery of second or third child in Pepople's Hospital of Nanxun Dis-trict from February 2022 to December 2023 were selected as the study objects and divided into a control group and an observation group according to treatment methods,with 43 cases in each group.After cesarean delivery,the two groups were treated with sufentanil and esketamine combined with sufentanil for analgesia,respectively.Pain scores,postpartum recovery,depression and sleep quality were compared between the two groups.Results The VAS pain scores in the observation group were significantly lower than those in the control group at 6 h,12 h,24 h and 48 h after surgery(P＜0.05).The first anal exhaust,bladder recovery urination,and colostrum secretion time in observation group were significantly shorter than those in control group(P＜0.05).The EPDS depression scores in the observation group were significantly lower than those in the control group at 3 d,7 d,14 d and 28 d after surgery(P＜0.05).The incidence of sleep disorders in the observation group was significantly lower than that in the control group at 1 d,2 d,and 3 d after surgery(P＜0.05).The total incidence of adverse reactions to postop-erative analgesia in the observation group was significantly lower than that in the control group(P＜0.05).Conclu-sion For obese pregnant women who have cesarean delivery of second or third child,postoperative analgesia with esketamine can significantly reduce their pain and depression,promote postpartum recovery,reduce the incidence of sleep disorders,and have few adverse reactions,which deserves attention.