Department of Anaesthesiology, Obstetrics and Gynaecology Hospital, Fudan University, 128 Shenyang Rd., Yangpu District, Shanghai, 200090, China.
Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA.
Can J Anaesth. 2023 Oct;70(10):1623-1634. doi: 10.1007/s12630-023-02564-6. Epub 2023 Sep 15.
Although the Enhanced Recovery After Cesarean Delivery (ERAC) consensus statement provides recommendations for early postoperative drinking and eating, evidence from high-quality clinical research directly addressing parturients is sparse. Our objective was to assess if early oral carbohydrate intake after elective Cesarean delivery improves maternal recovery.
In this randomized controlled trial, we enrolled parturients undergoing elective Cesarean delivery under spinal anesthesia with tympanic membrane temperatures ≤ 36.5 °C immediately upon arrival at the postanesthesia care unit. Parturients were randomized to either 100 mL of oral complex carbohydrate intake (group CC) or 10 mL of water (group C). The primary outcome was maternal tympanic membrane temperature. Other outcomes included maternal thermal comfort score, degree of shivering, satisfaction, degree of thirst and hunger, and gastric emptying assessed by ultrasonography.
We included 90 participants in the final analysis. The mean (standard deviation [SD]) maternal body temperature at 120 min after ingestion was 36.7 (0.3) °C in group CC and 36.6 (0.3) °C in group C (difference in means, 0.14 °C; 95% confidence interval, 0.02 to 0.26; P = 0.02). Furthermore, using repeated measure models, the linear trends of temperature changes over time between groups CC and C were significantly different (P = 0.04). The thermal comfort scores at 120 min after ingestion were higher in group CC than in group C (P = 0.02), and the linear trends of shivering score changes over time between groups CC and C also were different (P = 0.003). The mean (SD) visual analogue scale scores for maternal satisfaction were 84 (13) mm in group CC and 47 (20) mm in group C (P < 0.001). Nevertheless, at 90 and 120 min after ingestion, there were no differences between the two groups in the number of participants with a gastric antrum cross-sectional area > 10.3 cm.
Early oral carbohydrate intake after Cesarean delivery helped to restore maternal body temperature postoperatively and improve maternal satisfaction. Nevertheless, the clinical importance of these finding is unclear, given that most of the differences were small. In addition, there was no delay in maternal gastric emptying after consumption of a complex carbohydrate beverage in the early post-Cesarean period.
www.chictr.org.cn (ChiCTR2000031085); first submitted 13 November 2022.
尽管《剖宫产术后加速康复（ERAC）共识声明》对产妇术后早期饮水和进食提出了建议，但直接针对产妇的高质量临床研究证据仍然较少。本研究旨在评估择期剖宫产术后早期口服碳水化合物摄入是否能改善产妇的康复情况。
本随机对照试验纳入了体温≤36.5°C 的产妇，她们在麻醉后复苏室（PACU）中接受择期脊髓麻醉下的剖宫产。产妇被随机分为口服 100mL 复合碳水化合物组（CC 组）或口服 10mL 水组（C 组）。主要结局是产妇的鼓膜温度。其他结局包括产妇的热舒适度评分、寒战程度、满意度、口渴和饥饿程度以及超声评估的胃排空情况。
本研究最终纳入了 90 名参与者进行分析。CC 组产妇在摄入后 120 分钟时的平均（标准差）体温为 36.7（0.3）℃，C 组为 36.6（0.3）℃（组间差异，0.14℃；95%置信区间，0.02 至 0.26；P=0.02）。此外，使用重复测量模型，CC 组和 C 组之间的鼓膜温度随时间的线性变化趋势存在显著差异（P=0.04）。CC 组产妇在摄入后 120 分钟时的热舒适度评分高于 C 组（P=0.02），CC 组和 C 组之间的寒战评分随时间的线性变化趋势也存在差异（P=0.003）。CC 组产妇的满意度平均（标准差）视觉模拟评分（VAS）为 84（13）mm，C 组为 47（20）mm（P<0.001）。然而，在摄入后 90 分钟和 120 分钟时，两组中胃窦横截面积>10.3cm²的参与者数量无差异。
剖宫产术后早期口服碳水化合物有助于恢复产妇术后体温，并提高产妇满意度。然而，鉴于大多数差异较小，这些发现的临床重要性尚不清楚。此外，在剖宫产术后早期饮用复合碳水化合物饮料后，产妇的胃排空没有延迟。
www.chictr.org.cn（ChiCTR2000031085）；首次提交日期：2022 年 11 月 13 日。
