Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia.
Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia.
Am J Perinatol. 2022 Oct;39(13):1375-1382. doi: 10.1055/a-1799-5582. Epub 2022 Mar 15.
The objective of this study was to assess the efficacy of an enhanced recovery after surgery (ERAS) protocol and determine its effect on racial/ethnic disparities in postcesarean pain management.
We performed an institutional review board-approved retrospective cohort study of scheduled cesarean deliveries before and after ERAS implementation at a single urban academic institution. Pre-ERAS, all analgesic medications were given postoperatively on patient request. The ERAS protocol included preoperative acetaminophen and celecoxib. Postoperatively, patients received scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Oral oxycodone was available as needed, and opioid patient-controlled analgesia was eliminated from the standard order set. The primary outcome was total opioid use in the first 48 hours after cesarean, pre- and post-ERAS, reported in total milliequivalents of intravenous morphine (MME). A secondary analysis of opioid use and pain scores by racial groups was also performed. Chi-square, independent -tests, analysis of variance, Mann-Whitney , and Kruskal-Wallis tests were used depending on variable and data normality.
Pre-ERAS and post-ERAS groups included 100 women each. Post-ERAS, total opioid use in 48 hours was less (40.8 vs. 8.6 MME, < 0.001) and visual analog scale (VAS) pain scores were lower on postoperative day 1 (POD1) and 2 (POD2) (POD1 maximum at rest: 6.7 vs. 5.3, < 0.001). Pre-ERAS pain scores differed by race with non-Hispanic Black (NHB) patients reporting the highest mean and max VAS pain scores POD1 and POD2 (POD1, maximum VAS at rest: NHB-7.4, non-Hispanic White-6.6, Hispanic-5.8, Asian-4.4, = 0.006). Post-ERAS, there were no differences in postoperative pain scores between groups with movement on POD1 and POD2.
A standardized ERAS protocol for postcesarean pain decreases opioid use and may improve some racial disparities in postcesarean pain control.
· ERAS protocols improve postoperative pain control and lower postoperative opioid use.. · Studies show that there are racial and ethnic disparities in postpartum pain control.. · Protocols standardize care and may decrease the effects of provider implicit bias..
本研究旨在评估术后加速康复（ERAS）方案的疗效，并确定其对剖宫产术后疼痛管理中种族/民族差异的影响。
我们对单家城市学术机构实施 ERAS 前后的择期剖宫产进行了机构审查委员会批准的回顾性队列研究。在 ERAS 之前，所有镇痛药物均根据患者要求在术后给予。ERAS 方案包括术前使用对乙酰氨基酚和塞来昔布。术后，患者接受计划使用非甾体抗炎药和对乙酰氨基酚。口服羟考酮按需提供，阿片类药物患者自控镇痛已从标准医嘱中删除。主要结局是剖宫产术后 48 小时内的总阿片类药物使用量，在 ERAS 前后以静脉注射吗啡等效剂量（MME）表示。还按种族进行了阿片类药物使用和疼痛评分的二次分析。根据变量和数据正态性，使用卡方检验、独立样本 t 检验、方差分析、Mann-Whitney U 检验和 Kruskal-Wallis 检验。
ERAS 前后组各纳入 100 名女性。ERAS 后，48 小时内总阿片类药物使用量减少（40.8 与 8.6 MME， < 0.001），术后第 1 天（POD1）和第 2 天（POD2）的视觉模拟评分（VAS）疼痛评分较低（POD1 最大休息时：6.7 与 5.3， < 0.001）。术前疼痛评分因种族而异，非西班牙裔黑人（NHB）患者报告 POD1 和 POD2 的平均和最大 VAS 疼痛评分最高（POD1，最大 VAS 休息时：NHB-7.4，非西班牙裔白人-6.6，西班牙裔-5.8，亚裔-4.4， = 0.006）。ERAS 后，运动时 POD1 和 POD2 各组之间的术后疼痛评分无差异。
剖宫产术后疼痛的标准化 ERAS 方案可减少阿片类药物的使用，并可能改善剖宫产术后疼痛控制中的一些种族差异。
· ERAS 方案可改善术后疼痛控制并降低术后阿片类药物使用量。· 研究表明，产后疼痛控制存在种族和民族差异。· 方案标准化可减少提供者隐性偏见的影响。
