<p>The Advantage of Implementation of Enhanced Recovery After Surgery (ERAS) in Acute Pain Management During Elective Cesarean Delivery: A Prospective Randomized Controlled Trial</p>

Abstract

The aim of this study was to test whether the implementation of an enhanced recovery after surgery (ERAS) protocol for patients undergoing elective cesarean delivery has a positive impact on the postoperative status of the patients in terms of pain management, hospital stay, hospitalization costs, and adverse reactions. Methods: Patients who underwent elective cesarean delivery were randomized into two groups -ERAS group and control groupand the groups were managed with the ERAS protocol and traditional protocol, respectively. Results: Compared to the control group, the ERAS group had significantly fewer patients with intraoperative nausea, pain of visual analog scale (VAS) scores, and VAS grade >3 during rest in the first 24 h and during motion in the first 24 and 48 h after surgery. There were no intergroup differences in the requirement of extra analgesics, the incidence of vomiting, shivering, hypotension, postoperative nausea, and pruritus. None of the patients in either group had postoperative vomiting. Patient satisfaction rated as per the VAS was significantly higher in the ERAS group than in the control group. The total length of stay, postoperative length of stay, and the cost of anesthesia in both groups were comparable. Further, the average daily hospitalization cost was significantly lower in the ERAS group than in the control group. Conclusion:The ERAS protocol shows promise and appears to be worthwhile for widespread implementation among patients undergoing elective cesarean delivery; it was found to be beneficial in reducing the postoperative pain, incidence of intraoperative nausea, and average cost of hospitalization and also improved patient satisfaction.

The Clinical Efficacy and Safety of Enhanced Recovery After Surgery for Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

“…However, due to the limited studies assessing data of hospital cost, more high-quality trials were needed to determine the true cost-effectiveness of ERAS. We speculate that the saving of hospital costs mainly benefits from shorter hospital stay, reduced drugs, and lower complication rate, although ERAS contains the use of diverse medical care modalities and treatment approaches ( 17 ). The present encouraging results would greatly promote the implementation of ERAS protocols in maternity units.…”

Fluid loading therapy to prevent spinal hypotension in women undergoing elective caesarean section

“…The available data are not convincing, that this form of oral prehydration really does prevent spinal anaesthesia-induced hypotension. 84 , 85 On the contrary, prevention of hypotension has been shown to contribute to enhanced recovery and therefore must be promoted. 86 …”

Features of using accelerated rehabilitation protocols in obstetrics: literature review

“…Принципы ус коренной реабилитации включают меро приятия, охватывающие предоперационный, интраоперационный и послеоперационный периоды. Они призваны ускорить восста новление, снизить частоту осложнений, ми нимизировать пребывание в стационаре, сократить расходы медицинской организа ции без ущерба для пациента, повысить комфортность лечения [8][9][10][11]. Американские ученые в ходе исследований 2017-2018 гг.…”

“…Преимущества ERAS , FTS протоколовэто снижение количества дней пребывания в стационаре, уменьшение послеоперационной боли и необходимости обезболивания, бы строе восстановление функции кишечника, снижение количества осложнений, повышение удовлетворенности пациентов [1,10,11]. Ком плексное применение принципов ускоренной реабилитации в акушерстве позволяет добить ся хороших результатов как со стороны мате ри, так и новорожденного.…”

“…Снижает материн скую смертность, улучшает показатели грудно го вскармливания. Одновременно с этим применение протоколов FTS и ERAS несет прямую экономическую выгоду для учрежде ния, повышает престиж лечащего врача [10,16,44,49]. Ускоренная реабилитация -резерв по вышения клинической и экономической эф фективности лечения.…”