Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Int J Obstet Anesth. 2020 Aug;43:47-55. doi: 10.1016/j.ijoa.2020.01.005. Epub 2020 Jan 22.
Cesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption.
We compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0-10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions.
Data from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P <0.001). The number of patients who required opioid medication within 24 h of discharge was significantly reduced in the enhanced recovery cohort (41.1% vs 74.6%, P <0.001). There were no significant differences in average pain scores (1.6 vs 1.9, P=0.037).
The implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining <2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.
剖宫产术是全球最常见的手术之一，越来越多的人采用加速康复方案来实施剖宫产术。我们检验了这样一个假设，即实施剖宫产加速康复方案与术后阿片类药物消耗的减少有关。
我们比较了 2017 年 1 月 1 日至 2018 年 6 月 30 日接受择期剖宫产的回顾性队列和 2018 年 7 月 1 日至 2018 年 12 月 31 日接受加速康复方案的前瞻性队列。主要结局是住院产妇的阿片类药物使用情况，用口服吗啡等效剂量来衡量。次要结局包括术后 0-10 分疼痛评分、住院时间、30 天术后并发症发生率和医院再入院率。
分析了 541 名患者的数据。与术前加速康复组相比，加速康复组患者使用的口服吗啡等效剂量明显减少（60.3mg 比 104.3mg，P<0.001）。加速康复组患者在出院后 24 小时内需要阿片类药物的人数明显减少（41.1%比 74.6%，P<0.001）。平均疼痛评分（1.6 比 1.9，P=0.037）无显著差异。
实施剖宫产加速康复方案与术后住院期间阿片类药物消耗的显著减少有关，平均疼痛评分仍<2。该方案的实施还与出院前 24 小时内无阿片类药物使用的患者数量增加有关。
