Senn Laura, Anand Sulekha
Nurs Womens Health. 2024 Dec;28(6):473-484. doi: 10.1016/j.nwh.2024.05.004. Epub 2024 Oct 4.
To evaluate the enhanced recovery after surgery (ERAS) protocols used and amount of opioids administered during hospitalization for cesarean birth after the ERAS protocols were implemented.
A search was conducted in CINAHL Complete, Scopus, and PubMed for sources published in English between January 2018 and December 2023. Search terms were cesarean AND opioid∗ AND eras OR erac OR enhanced recovery.
Eligible studies were conducted in the United States, used key pain management components from the ERAS guidelines, and reported results for in-patient postsurgical opioid use.
Data obtained were for post-ERAS implementation only and included authors, date, sample size, study location, participant inclusion and exclusion criteria, methods, interventions used (ERAS guideline components), and morphine milligram equivalents (MME) used during the hospital stay.
Weighted averages were calculated for results reported as means and percentages. Descriptive summaries were used for the remainder of the results.
Twenty-six studies were found, accounting for 19,961 individuals' post-ERAS experiences. Although 30% of participants experienced a scheduled cesarean birth, 70% experienced all types of cesarean births, including scheduled, urgent, or emergent. There was substantial heterogeneity of the data reported, especially for how opioid use was measured and analyzed and time frames for opioid use. In 11 studies that reported MME as means, the weighted average for in-patient opioid use was 54 MME per stay. In only 17 studies, researchers reported the number of women who experienced an opioid-free recovery, which averaged 40% of the women.
While implementation of key components of the ERAS protocol is associated with reduced opioid exposure for women experiencing scheduled and nonscheduled cesarean births, a benchmark for the amount of in-patient opioid use was not established. Still, this review offers evidence regarding best practices, lessons learned, and outcome analysis strategies. These findings can support perinatal teams who are considering implementing ERAS for cesarean birth, or those looking for further improvements.
评估实施加速康复外科（ERAS）方案后，剖宫产住院期间所采用的ERAS方案及阿片类药物的使用量。
于2018年1月至2023年12月期间在CINAHL Complete、Scopus和PubMed中检索英文发表的文献。检索词为剖宫产、阿片类药物∗、ERAS或ERAC或加速康复。
符合条件的研究在美国开展，采用了ERAS指南中的关键疼痛管理要素，并报告了术后住院期间阿片类药物的使用结果。
获取的数据仅为ERAS实施后的情况，包括作者、日期、样本量、研究地点、参与者纳入和排除标准、方法、所采用的干预措施（ERAS指南要素）以及住院期间使用的吗啡毫克当量（MME）。
对以均值和百分比形式报告的结果计算加权平均值。其余结果采用描述性总结。
共找到26项研究，涉及19961名个体的ERAS实施后经历。虽然30%的参与者接受了择期剖宫产，但70%经历了所有类型的剖宫产，包括择期、紧急或急诊剖宫产。报告的数据存在很大异质性，特别是在阿片类药物使用的测量和分析方法以及阿片类药物使用的时间范围方面。在11项将MME作为均值报告的研究中，住院期间阿片类药物使用的加权平均值为每次住院54 MME。只有17项研究报告了无阿片类药物康复的女性人数，平均占女性的40%。
虽然ERAS方案关键要素的实施与择期和非择期剖宫产女性的阿片类药物暴露减少相关，但未确立住院期间阿片类药物使用量的基准。尽管如此，本综述提供了关于最佳实践、经验教训和结果分析策略的证据。这些发现可为考虑在剖宫产中实施ERAS的围产期团队或寻求进一步改进的团队提供支持。
