Elective Cesarean Section, Enhanced Recovery After Surgery (ERAS), Postoperative Recovery
Conditions
Keywords
Cesarean Section, Elective Cesarean, Enhanced Recovery After Surgery, ERAS, Postoperative Recovery, Early Mobilization, Postoperative Pain, Multimodal Analgesia, Obstetric Surgery
Brief summary
This study evaluates the effect of the Enhanced Recovery After Surgery (ERAS) protocol on early postoperative recovery in women undergoing elective cesarean section. Eighty-four pregnant women, aged 18 years or older, at 37 weeks of gestation or beyond, without chronic medical conditions, and classified as ASA I-II, were enrolled. Participants were randomly assigned to either: ERAS group - received the ERAS protocol, including early oral intake, early mobilization, multimodal analgesia, and enhanced perioperative care Control group - received standard perioperative cesarean section care The study compared breastfeeding initiation time, gas passage, oral intake, mobilization time, and postoperative pain scores (VAS) between the two groups. The aim is to determine whether ERAS can accelerate recovery, reduce pain, and improve maternal comfort after elective cesarean delivery.
Detailed description
Enhanced Recovery After Surgery (ERAS) protocols aim to accelerate postoperative recovery, reduce complications, and shorten hospital stays. While ERAS has been widely implemented in general and gynecologic surgeries, its application in obstetric surgery, particularly elective cesarean delivery, remains limited. This single-center, prospective, randomized clinical trial was conducted at the University of Health Sciences, Istanbul Gaziosmanpasa Training and Research Hospital, between October 2022 and December 2022. Eighty-four women scheduled for elective cesarean section were enrolled. Eligible participants were 18 years or older, at ≥37 weeks of gestation, ASA I-II, without chronic comorbidities, and provided written informed consent. Participants were randomized (1:1) into two groups: ERAS group: Managed with ERAS protocol including early oral intake, early mobilization, multimodal analgesia with opioid-sparing strategies, prophylactic antiemetics, early urinary catheter removal, and gum chewing to stimulate bowel function. Control group: Managed with standard perioperative cesarean care including delayed oral intake, standard pain management, and later mobilization. Primary outcomes included breastfeeding initiation time, gas passage, time to oral intake, mobilization time, and postoperative pain scores (VAS at 24 and 48 hours). Secondary outcomes included nausea-vomiting incidence and overall postoperative recovery profile. The study aims to determine whether ERAS protocols improve postoperative recovery and patient comfort after elective cesarean section and to support the implementation of ERAS as a standard in obstetric surgery.
Interventions
BEHAVIORALEnhanced Recovery After Surgery (ERAS) Protocol, which includes early oral intake, early mobilization, opioid-sparing multimodal analgesia, prophylactic antiemetics, early urinary catheter removal, an
The Enhanced Recovery After Surgery (ERAS) Protocol for elective cesarean section includes a multimodal perioperative care approach aimed at accelerating postoperative recovery. Key components are early oral intake, early mobilization, opioid-sparing multimodal analgesia, prophylactic antiemetics, early removal of the urinary catheter, and gum chewing to stimulate bowel function. This protocol is compared with Standard Perioperative Cesarean Care, which involves overnight fasting, delayed oral intake until bowel function returns, conventional analgesia, later mobilization, and routine catheter removal.
Sponsors
Havva Betül Bacak
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a single-center, prospective, randomized, parallel-group clinical trial. Participants were randomly assigned in a 1:1 ratio to either the ERAS protocol group or the standard care control group. Both groups were followed concurrently for postoperative recovery outcomes after elective cesarean section.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Pregnant women aged 18 years or older Gestational age ≥37 weeks Classified as ASA I or ASA II Scheduled for elective cesarean section under spinal anesthesia Able and willing to provide informed consent No chronic systemic diseases
Exclusion criteria
Age \<18 years Gestational age \<37 weeks Emergency cesarean delivery ASA III or higher Presence of obstetric complications (e.g., preeclampsia, placenta previa, placental abruption, fetal distress) Chronic comorbidities (e.g., diabetes, hypertension, cardiac or pulmonary disease) Declines spinal anesthesia or unable to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Mobilization After Cesarean Section | Within 24 hours postoperatively | Time from the end of elective cesarean section surgery to the patient's first ambulation, measured in hours. Early mobilization reflects enhanced postoperative recovery and is a key indicator of the ERAS protocol's effectiveness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Postoperative Nausea and Vomiting | Within 48 hours postoperatively | Assessment of the presence and duration of postoperative nausea and vomiting (PONV) following elective cesarean section. Nausea and vomiting episodes will be recorded and analyzed to compare the incidence between the ERAS protocol group and the standard care group. |
Countries
Turkey (Türkiye)
Outcome results
None listed