1. Current guidelines of Enhanced Recovery After Surgery (ERAS) recommend
food and liquid intake perioperatively 6
hours and 2 hours respectively, for caesarean section to prevent
complications. ERAS accelerates patient recovery by standardizing
perioperative care, including preoperative counselling and early mobilization.
A study in India found that ERAS improved breastfeeding initiation, with 50.5%
starting within the first hour and 34.7% within 2 to 4 hours postoperatively,
compared to traditional care. ERAS also led to earlier ambulation, catheter
removal, and reduced analgesic requirement, resulting in higher Quality of
Recovery (QoR) scores at 24 hours postoperative. Despite the significant body
of evidence indicating that ERAS protocols lead to improved outcomes, they
challenge traditional surgical doctrine, and as a result their implementation
has been slow. Therefore this study is being conducted with an objective to
implement predefined ERAS protocol for better management of elective cesarean
section patients, to compare quality of recovery based on obstetric-specific
QoR 11 questionnaire. between patients undergoing ERAS and traditional protocol
for elective LSCS, To compare the intensity of pain using Visual Analog Scale
(VAS) score, Comparison of total duration of hospitalization between ERAS and
traditional protocols, To evaluate the requirement of analgesics within 24
hours between both groups, To evaluate the duration in which the mobilization
was initiated post operatively between both group.
2. All pregnant patients
with gestational age ≥ 34 weeks, Patients under ASA grade I-II, Patients
scheduled for elective cesarean section surgery will be included in the study.
However, the patients with preexisting cardiac disease, extreme preterm labor
< 34 weeks, diabetes, autoimmune disorder, severe and uncontrolled
hypertension. , severe uncontrolled hypo/hyperthyroidism. patients with
antepartum hemorrhage i.e., abruption placenta and placenta previa will be
excluded from the study
3. This study is two arm in which the patients will
be randomized based on computer based randomization technique
4. The patients who are randomized in Arm 1
(Control group) will follow the traditional method i.e. “fasting from
midnight†which includes no food before 12 hours and no liquid intake before 6
hours perioperatively.
5. The patients who are randomized in Arm 2
(Interventional group) will follow ERAS pathway procedure which includes the
following
A. Preoperative procedures a day before the
surgery.
a. Education:
§ Dedicated preoperative
counselling.
§ Counselling for enhanced protocol which will
include details of ERAS program: its goals and benefits, spinal anaesthesia,
benefits of early skin to skin contact and breast feeding.
B. On the day of surgery:
§ Fasting for solid 6 h prior to surgery
§ Clear liquid will be allowed till 2 h before surgery.
§ 25 g of glucose dissolved in 200 ml of water 2 h before surgery
C. Post surgery:
A. Resumption of oral intake
§ Chewing gum/Lozenges and sips of water at 2h.
§ Clear fluid/juices at 4 h. Semisolid at 8 h after
surgery.
B. Mobilization
§ Early mobilization within 6 h of
surgery.
The patients enrolled in both
the groups will be assessed based on following questionnaire:
A. The recovery will be
assessed by using the recovery based on obstetric-specific QoR 11 questionnaire
in the timepoint of 12 hours ,24 hours postoperatively and at the timepoint of
discharge.
B. The pain will be evaluated
by using Visual Analog Scale (VAS Scale) on the day of surgery, 12 hours and 24
hours postoperatively and at the timepoint of discharge.
C. At the timepoint of
discharge (Day n): The patient feeding, mobilization patterns and QOL will be
captured by using “Patient Questionnaire†which is validated and approved by EC
6.
The data
parameters includes the above mentioned questionnaires as well as , total hours
within which attempt for mobilization was performed, total hours within which
breast feeding was initiated,requirement of analgesics within 24 hours, total
hours within which the catheter was removed post operatively, number of days of
hospitalization, duration in which the bowel movement is back to normal, need
for readmission of the patient (Yes/No) will be recorded
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