Enhanced Recovery After C-Section; Experience at KGH

Abstract

Objective: To evaluate the effectiveness of the enhanced recovery after cesarean (ERAS) protocol in enhancing postoperative recovery after cesarean delivery versus conventional care at a tertiary care setting.

Methodology: A prospective observational study was conducted at gynae and OBS department of Kharadar General Hospital (KGH) Karachi from April 2024 to Sept 2024. Patients aged 18 years to 40 years old presented with singleton pregnancy and selected for elective cesarean section were included. Both groups underwent the same surgical technique. ERAS group followed a structured protocol with goal-directed IV fluids, early oral intake, mobilization starting within 8 hours, early catheter removal, dressing change at 24 hours, multimodal pain relief, and a shorter course of IV antibiotics followed by oral antibiotics, while control group received standard care with fixed-rate IV fluids, delayed oral intake and mobilization, delayed catheter removal, dressing change on day 3, and a longer duration of IV analgesia and antibiotics. Data were recorded and analyzed using SPSS version 26.

Results: Mean age of participants in the ERAS group was 25.3 years and in control group was 29.7 years. The mean IV fluid duration was markedly shorter in the ERAS group (10.18?±?1.64 hours) vs. control (24.00?±?0.00 hours), (p-0.001). Oral intake began earlier in ERAS group (5.22?±?1.61 vs. 11.87?±?1.62 hours), and mobilization was initiated sooner (7.64?±?1.50 vs. 35.47?±?10.22 hours), both with p-0.001. Removal of catheter and dressing changes also occurred earlier in the ERAS group (p-0.001). IV antibiotics duration was also reduced in ERAS group (25.07?±?3.45 vs. 46.67?±?3.81 hours), while oral antibiotic use was similar (5 days). Additionally the pain scores at 24 hours was found decreased in ERAS group (3.40?±?1.18 vs. 5.91?±?1.52) and hospital stay (1.73?±?0.62 vs. 5.02?±?0.87 days) p- 0.001 respectively.

Conclusion: Implementation of ERAS protocol observed significantly improved postoperative outcomes compared to conventional care, in terms of earlier oral intake and ambulation, reduced durations of IV fluids, catheterization, and antibiotics, better pain control, and shorter hospital stays, enhanced patient comfort, and more efficient use of hospital resources.