Eras protocol applications in caesarean surgery

Abstract

Cesarean section is the most common major obstetric surgery in the world. Although a safe application today, it can cause some complications. Accelerated recovery protocols (ERAS) have been developed to minimize postoperative complications and provide early recovery in patients. Cesarean is the first and only surgical intervention in obstetrics and perinatology using the ERAS protocol. Many studies about the ERAS protocol in cesarean determined that it reduced the duration of hospital stay by 2-3 days and the morbidity and complication rate by 30-50%. Evidence-based studies for preoperative, intraoperative, and postoperative care are included in the guidelines created by the ERAS association specific to the cesarean. This review aims to share evidence-based care and results within the scope of ERAS for cesarean operations and to provide a guide for cesarean care in this context.

Keywords

• Cesarean section
• ERAS protocol
• Evidence-based practices.

References

1. Sayın N, Erzincan S, Çilingir I. Sezaryen: kanıta dayalı bilgiler. Turkiye Klinikleri J Gynecol Obst-Special Topics. 2018;11(1):76-81.
2. TNSA. Ana rapor Ankara [Internet]. 2018 [cited 10.11.2020]. Available from: http://www.hips.hacettepe.edu.tr/tnsa2018/rapor/TNSA2018_ana_Rapor.pdf
3. Ergöl Ş, Kürtüncü M. Bir üniversite hastanesinde kadınların sezaryen doğum tercihlerini etkileyen faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2014; 1(3): 26-34.
4. Altuntaş H, Dansuk R, Köse O. Sezaryen oranlarının çeşitli değişkenlere bağlı olarak değerlendirilmesi. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2013; 15(2): 1-7.
5. Çağlayan EK, Kara M, Gürel YC. Kliniğimizdeki sezaryen operasyonlarında görülen komplikasyonlar ve olası risk faktörlerinin değerlendirilmesi. Bakırköy Tıp Dergisi. 2011; 7(2): 64-7.
6. Gökçe AH, Ozkan A, Gökçe FS. Endometriosis at the incision site after C-section procedure. Pamukkale Tıp Dergisi. 2020; 13(2): 369-72.
7. Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth. 2015 Feb;62(2):99-104. doi: 10.1007/s12630-014-0261-3.
8. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952..

9. Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, et al. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am J Obstet Gynecol. 2018 Dec;219(6):523.e1-523.e15. doi: 10.1016/j.ajog.2018.09.015.
10. Yurashevich M, Chow A, Kowalczyk JJ, Traynor AJ, Carvalho B. Preoperative Fasting Times for Patients Undergoing Caesarean Delivery: Before and After a Patient Educational Initiative. Turk J Anaesthesiol Reanim. 2019 Aug;47(4):282-286. doi: 10.5152/TJAR.2019.95770.
11. Yılmaz G, Akça A, Esen O, Salihoğlu Z. Elektif sezaryen günündeki multimedya eğitimi kaygı puanlarını artırmaktadır. Perinatoloji 2019; 27(1): 4.
12. Taşdemir D, Karaman E, Yıldız A, Han A, Karaman Y, Talay H. Obezitenin term gebelerde maternal ve fetal sonuçlara etkisi: Bir olgu kontrol çalışması. İKSST Dergisi. 2015; 7(2): 73-8.
13. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014 Apr 15;348:g2301. doi: 10.1136/bmj.g2301.
14. Kaya R, Karaçam Z. Gestasyonel diyabet görülme sıklığı ve anne-bebek sağlığı ile ilişkisi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2019;9(1):10-8.
15. Bülbül R, Işıkalan MM, Acar A. Sezaryen doğum sonrasinda postpartum hemorajinin önlenmesinde uygulanan karbetosin ve oksitosinin etkinliğinin karşilaştirilmasi. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2020; 22(3): 386-92.
16. Hire MG, Lange EMS, Vaidyanathan M, Armour KL, Toledo P. Effect of Quantification of Blood Loss on Activation of a Postpartum Hemorrhage Protocol and Use of Resources. J Obstet Gynecol Neonatal Nurs. 2020 Mar;49(2):137-143. doi: 10.1016/j.jogn.2020.01.002.
17. Li Y, Su D, Sun Y, Hu Z, Wei Z, Jia J. Influence of different preoperative fasting times on women and neonates in cesarean section: a retrospective analysis. BMC Pregnancy Childbirth. 2019 Mar 29;19(1):104. doi: 10.1186/s12884- 019-2254-2.
18. Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol. 2018 Dec;219(6):533-544. doi: 10.1016/j.ajog.2018.08.006.
19. Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, Welton NJ, O'Connor L, Cawthorne J, George RP, Crosbie EJ, Rithalia AD, Cheng HY. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2018 Feb 6;2(2):CD012653. doi: 10.1002/14651858.CD012653.pub2.
20. Hadiati DR, Hakimi M, Nurdiati DS, da Silva Lopes K, Ota E. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Rev. 2018 Oct 22;10(10):CD007462. doi: 10.1002/14651858.CD007462.pub4. Update in: Cochrane Database Syst Rev. 2020 Jun 25;6:CD007462.
21. Karaca I, Ozturk M, Alay I, Ince O, Karaca SY, Erdogan VS, Ekin M. Influence of Abdominal Binder Usage after Cesarean Delivery on Postoperative Mobilization, Pain and Distress: A Randomized Controlled Trial. Eurasian J Med. 2019 Oct;51(3):214-218. doi: 10.5152/eurasianjmed.2019.18457.
22. Gülhaş N, Özgül Ü, Begeç Z, Durmuş M. Sezaryenlerde Anestezi Yönetimi: Retrospektif Değerlendirme. Journal of Inonu University Medical Faculty. 2012; 19(3).
23. Wrench IJ, Allison A, Galimberti A, Radley S, Wilson MJ. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience. Int J Obstet Anesth. 2015 May;24(2):124-30. doi: 10.1016/j.ijoa.2015.01.003.
24. Perlman J, Kjaer K. Neonatal and Maternal Temperature Regulation During and After Delivery. Anesth Analg. 2016 Jul;123(1):168-72. doi: 10.1213/ANE.0000000000001256.
25. İmamoğlu Yalın E. Yenidoğanda Ateş ve Hipotermiye Yaklaşım. Klinik Tıp Aile Hekimliği. 2018; 10(4).
26. Duryea EL, Nelson DB, Wyckoff MH, Grant EN, Tao W, Sadana N. The impact of ambient operating room temperature on neonatal and maternal hypothermia and associated morbidities: a randomized controlled trial. Am J Obstet Gynecol. 2016 Apr;214(4):505.e1-505.e7. doi: 10.1016/j.ajog.2016.01.190.
27. Sultan P, Habib AS, Cho Y, Carvalho B. The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis. Br J Anaesth. 2015 Oct;115(4):500-10. doi: 10.1093/bja/aev325.
28. Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007 Nov;105(5):1413-9, table of contents. doi: 10.1213/01.ane.0000286167.96410.27.
29. du Toit L, van Dyk D, Hofmeyr R, Lombard CJ, Dyer RA. Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor. Anesth Analg. 2018 Jan;126(1):190-195. doi: 10.1213/ANE.0000000000002326.
30. Cantürk M, Cantürk FK, Kocaoğlu N, Hakki M. Os efeitos do aquecimento de cristaloides sobre a temperatura corporal materna e nas condições fetais: ensaio clínico randômico [The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial]. Braz J Anesthesiol. 2019 Jan-Feb;69(1):13-19. doi: 10.1016/j.bjan.2018.09.009.
31. Goyal P, Kundra S, Sharma S, Grewal A, Kaul TK, Singh MR. Efficacy of intravenous fluid warming for maintenance of core temperature during lower segment cesarean section under spinal anesthesia. Journal of Obstetric Anaesthesia and Critical Care. 2011; 1(2): 73.
32. Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database Syst Rev. 2014 Aug 11;2014(8):CD000163. doi: 10.1002/14651858.CD000163.pub2.
33. CORONIS Collaborative Group; Abalos E, Oyarzun E, Addo V, Sharma JB, Matthews J, Oyieke J, et al.. CORONIS - International study of caesarean section surgical techniques: the follow-up study. BMC Pregnancy Childbirth. 2013 Nov 21;13:215. doi: 10.1186/1471-2393-13-215.
34. Atabekoğlu CS, Türkçüoğlu I, Duru B, Sönmezer M, Süer G, Uysalel A, et al. Closure vs non-closure of peritoneum at caesarean section: evaluation of pain. J Obstet Gynaecol. 2011 May;31(4):307-10. doi: 10.3109/01443615.2011.560302.
35. McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Evid Based Child Health. 2014 Jun;9(2):303-97. doi: 10.1002/ebch.1971.
36. Kc A, Rana N, Målqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of Delayed Umbilical Cord Clamping vs Early Clamping on Anemia in Infants at 8 and 12 Months: A Randomized Clinical Trial. JAMA Pediatr. 2017 Mar 1;171(3):264-270. doi: 10.1001/jamapediatrics.2016.3971.
37. Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol. 2019 Sep;221(3):247.e1-247.e9. doi: 10.1016/j.ajog.2019.04.012.
38. Griffiths JD, Gyte GM, Paranjothy S, Brown HC, Broughton HK, Thomas J. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD007579. doi: 10.1002/14651858.CD007579.pub2. Update in: Cochrane Database Syst Rev. 2021 May 18;5:CD007579.
39. Lane B, Cannella K, Bowen C, Copelan D, Nteff G, Barnes K, et al. Examination of the effectiveness of peppermint aromatherapy on nausea in women post C-section. J Holist Nurs. 2012 Jun;30(2):90-104; quiz 105-6. doi: 10.1177/0898010111423419.
40. Booth JL, Harris LC, Eisenach JC, Pan PH. A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery. Anesth Analg. 2016 Apr;122(4):1114-9. doi: 10.1213/ANE.0000000000000695.
41. Hadley EE, Monsivais L, Pacheco L, Babazade R, Chiossi G, Ramirez Y, et al. Multimodal Pain Management for Cesarean Delivery: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. Am J Perinatol. 2019 Sep;36(11):1097-1105. doi: 10.1055/s-0039-1681096.
42. Ismail S. Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block. Journal of Obstetric Anaesthesia and Critical Care. 2012; 2(2): 67. Sezaryen Sonrası Tromboflaksisinin Uygulanan Olguların Değerlendirilmesi. Acıbadem Sağlık Bilimleri Dergisi. 2020; 11(4): 641-5.
43. Orji EO, Olabode TO, Kuti O, Ogunniyi SO. A randomised controlled trial of early initiation of oral feeding after cesarean section. J Matern Fetal Neonatal Med. 2009 Jan;22(1):65-71. doi: 10.1080/14767050802430826.
44. Utli H, Çalışkan N. Sakız çiğnemenin sezaryen sonrasi bağırsak fonksiyonlarına etkisi. Anatolian Journal of Clinical Investigation. 2013; 7(4).
45. Basbug A, Yuksel A, Ellibeş Kaya A. Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial. J Matern Fetal Neonatal Med. 2020 Jan;33(1):68-72. doi: 10.1080/14767058.2018.1487394.
46. Güleç T, Çoban A. Sezaryen Doğum Sonrası Taburculuk Eğitiminin Annelerin Taburculuğa Hazır Oluşluklarına Etkisi The Effect of Discharging of Cesarean Postpartum Discharge Training on the Readiness of the Mothers to the Discharge. Journal of Health Science and Profession 2019; 6(3): 461-9.