Effects of early rehabilitation on enhanced recovery after caesarean section

Rachida Mansouri, Abdelhamid Sadi, Hadjer Ziane, Nadia Fellah

Abstract

The objective of this study was to evaluate the impact of improved rehabilitation on the average length of stay after a scheduled caesarean section under neuraxial anaesthesia, it is a descriptive, monocentric study with prospective recruitment. Our protocol was based on neuraxial anaesthesia with intrathecal morphine, multimodal analgesia, with oral analgesics postoperatively, prevention of postoperative nausea and vomiting (PONV), rapid demedicalization, refeeding and mobilisation. We included 99 patients. The mean length of stay (LOS) for the current caesarean section was 1.97 days versus a LOS for previous caesareans of 4.14 days. On the day of discharge, the mean satisfaction with overall management was 8.97+/-1.35. At six weeks, 92.6% wanted to have the same protocol for a future caesarean. Early rehabilitation after caesarean section is quite applicable to the Algerian context. It offers a quick functional recovery with patient satisfaction, as well as a reduction of the length of stay. (Afr J Reprod Health 2023; 27 [9]: 134-142).

Full Text:

PDF

References

Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench

IJ, Huang J, Norman M, Pettersson K, Fawcett WJ,

Shalabi MM, Metcalfe A, Gramlich L and Nelson G.

Guidelines for Antenatal and Preoperative care in

Caesarean Delivery: Enhanced Recovery After

Surgery Society Recommendations (Part 1). Am J

Obstet Gynecol. 2018;219:523.e1-523.e15.

Kehlet H. Multimodal approach to control postoperative

pathophysiology and rehabilitation. Br J Anaesth.

;78:606-617.

Kehlet H. Fast-track surgery—an update on physiological

care principles to enhance recovery. Langenbecks

Arch Surg. 2011;396:585-590.

Coolsen MM, Wong-Lun-Hing EM, van Dam RM, van der

Wilt AA, Slim K, Lassen K and Dejong CH. A

systematic review of outcomes in patients

undergoing liver surgery in an enhanced recovery

after surgery pathways. HPB (Oxford). 2013;15:245-

Fagevik Olsén M and Wennberg E. Fast-Track Concepts in

Major Open Upper Abdominal and

Thoracoabdominal Surgery: A Review. World J

Surg. 2011;35:2586-2593.

Yu Z, Zhuang CL, Ye XZ, Zhang CJ, Dong QT and Chen

BC. Fast-track surgery in gastrectomy for gastric

cancer: a systematic review and meta-analysis.

Langenbecks Arch Surg. 2014;399:85-92.

Théry G, Vial Y and Hohlfeld P. Réhabilitation accélérée

multimodale postcésarienne, la somme de toutes les

astuces. Rev Med Suisse. 2010;2005-9.

Kehlet H. Enhanced Recovery After Surgery (ERAS): good

for now, but what about the future? Can J Anaesth.

;62:99-104.

Keïta H and Ducloy-Bouthors AS. Réhabilitation après

césarienne. Pas seulement une réhabilitation

postopératoire. Ann Fr Anesth Reanim.

;32:130-133.

Corso E, Hind D, Beever D, Fuller G, Wilson MJ, Wrench

IJ and Chambers D. Enhanced recovery after elective

caesarean: a rapid review of clinical protocols, and

an umbrella review of systematic reviews. BMC

Pregnancy Childbirth. 2017;17:91-101.

Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang

J, Norman M, Pettersson K, Fawcett WJ, Shalabi

MM, Metcalfe A, Gramlich L, Nelson G and Wilson

RD. Guidelines for intraoperative care in cesarean

delivery: Enhanced Recovery After Surgery Society

Recommendations (Part 2). Am J Obstet Gynecol.

;219:533-544.

Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang

J, Norman M, Pettersson K, Fawcett WJ, Shalabi

MM, Metcalfe A, Gramlich L, Nelson G and Wilson

RD. Guidelines for postoperative care in cesarean

delivery: Enhanced Recovery After Surgery (ERAS)

Society recommendations (part 3). Am J Obstet

Gynecol. 2019;221:247.e1-247.e9.

Faujour V and Slim K. Aspects économiques de la

réhabilitation améliorée après chirurgie. Le Praticien

en Anesthésie Réanimation. 2015;19:153-157.

Trowbridge ER, Dreisbach CN, Sarosiek BM, Dunbar CP,

Evans SL, Hahn LA and Hullfish KL. Review of

enhanced recovery programs in benign gynecologic

surgery. Int Urogynecol J. 2018;29:3-11.

Pędziwiatr M, Mavrikis J, Witowski J, et al. Current status

of enhanced recovery after surgery (ERAS) protocol

in gastrointestinal surgery. Med Oncol.

;35(6):95.

Rousseau A, Sadoun M, Aimé I, Leguen M, Carbonnel M

and Ayoubi JM. Étude comparative sur la

réhabilitation améliorée postcésarienne : quels

bénéfices, quels risques ? Gynecol Obstet Fertil

Senol. 2017;45:387-392.

Adamina M, Kehlet H, Tomlinson GA, Senagore AJ and

Delaney CP. Enhanced recovery pathways optimize

health outcomes and resource utilization: A metaanalysis of randomized controlled trials in colorectal

surgery. Surgery. 2011;149:830-840.

Kehlet H and Wilmore DW. Evidence-Based Surgical Care

and the Evolution of Fast-Track Surgery: Ann Surg.

;248:189-198.

Wrench IJ, Allison A, Galimberti A, Radley S and Wilson

MJ. Introduction of enhanced recovery for elective

caesarean section enabling next day discharge: a

tertiary centre experience. Int J Obstet Anesth.

;24:124-130.

Buchmann EJ, Pillay N and Katusiime C. Early discharge

from hospital after Caesarean section at Chris Hani

Baragwanath Hospital. SAJOG. 2011;17(1):17-18.

Tan PC, Norazilah MJ and Omar SZ. Hospital discharge on

the first compared with the second day after a

planned cesarean delivery: A Randomized

Controlled Trial. Obstet Gynecol. 2012;120:1273-

Ogbadua A, Agida T, Akaba G, Akitoye O and Ekele B.

Early versus delayed oral feeding after

uncomplicated cesarean section under spinal

anaesthesia: A Randomized Controlled Trial. Niger J

Surg. 2018;24(1):6.

Kehila M, Magdoud K, Touhami O, Abouda HS, Jeridi S,

Ben Marzouk S, Sami Mahjoub, Ben Hmid R and

Chanoufi MB. Sortie précoce en post-partum:

résultats et facteurs de risque de réhospitalisation.

Pan Afr Med J. 2016 ; 24.

Bougmiza I, El Ghardallou M, Zedini C, Lahouimel H,

Nabli-Ajmi T, Gataa R, Touati I, Khairi H and

Mtiraoui A. Evaluation de la satisfaction des

patientes hospitalisées au service de gynécologie

obstétrique de Sousse, Tunisie. Pan Afr Med J.

;8.

Benhamou D, Técsy M, Parry N, Mercier FJ and Burg C.

Audit of an early feeding program after Cesarean

delivery: patient wellbeing is increased. Can J

Anaesth. 2002;49:814-819.

Halder S, Onwere C, Brennan C, Singh N, Cox M and

Yentis SM. PA.07 Enhanced recovery programme

for elective caesarean section: Arch Dis Child Fetal

Neonatal Ed. 2014;99:A19.1-A19

Refbacks

  • There are currently no refbacks.