Özdemir Miray Gözde, Gunaydin Berrin, Bayram Merih, Hirfanoglu İbrahim Murat
Department of Anesthesiology & Reanimation, Gazi University School of Medicine, Ankara, Turkey.
Department of OBGYN (Recently retired), Gazi University School of Medicine, Ankara, Turkey.
BMC Pregnancy Childbirth. 2025 Apr 29;25(1):517. doi: 10.1186/s12884-025-07583-3.
We aimed to investigate the maternal, fetal, and neonatal outcomes in parturients scheduled to undergo cesarean section (CS) receiving either standard care or enhanced recovery after surgery (ERAS) protocol.
After approval of ethics committee (Gazi University Protocol Record Decision no: 502/31.05.2021) and registry to clinical trials (NCT06753058, Date 12/30/2024) 450 ASA II-III parturients at ≥ 18 years of age scheduled for elective CS under spinal anesthesia using bupivacaine plus opioids were included (n = 150, ERAS group and n = 300, control group). The ERAS protocol included restricting the fasting period before and after the surgery, administering oral nonparticulate carbohydrate solution (25 g of maltodextrin) 2 h (h) before surgery, intraoperative multimodal analgesia under spinal anesthesia and postoperative nausea and vomiting prophylaxis with intravenous (IV) 10 mg metoclopramide + 1.5 mg granisetron; postoperative analgesia was provided with IV nonsteroidal anti-inflammatory drug + paracetamol. While mother-baby contact was provided for both groups, all babies in the ERAS group were encouraged to breastfeed as soon as they were born. Maternal fasting duration, flatus, mobilization, urinary catheter removal times, postoperative visual analogue scale (VAS), rescue analgesic requirement, incidence of postoperative nausea-vomiting (PONV), length of stay (LOS), complications, Turkish version of the Obstetric Quality of Recovery Score 11 (ObsQoR-11T), were recorded in both groups. Newborn demographics, APGAR scores, umbilical cord blood gas analysis, nutritional and breastfeeding status and complications were also recorded.
In the ERAS group the ObsQoR-11T scores were better than the control group (p < 0.001). Maternal preoperative and postoperative fasting duration, postoperative first flatus and mobilization times and LOS, postoperative VAS, rescue analgesic requirement in the ERAS group were shorter than the control (p < 0.001, p = 0.034, p < 0.001 and p = 0.018, p < 0.001, p < 0.001) and the incidence of PONV was less (p = 0.001). The pH and pO were different between the groups.
We suggest that ERAS use is favorably promising to achieve better maternal recovery in terms of ObsQoR and improved neonatal outcome in terms of nutrition and breastfeeding in the ERAS pathway.
This study was retrospectively registered to clinical trials (NCT06753058 and published on 12/30/2024, 09:19) according to instructions at https://www.biomedcentral.com/getpublished/editorial-policies#trial+registration .
我们旨在研究计划接受剖宫产（CS）的产妇接受标准护理或术后加速康复（ERAS）方案后的母儿及新生儿结局。
在伦理委员会批准（加齐大学方案记录决定编号：502/31.05.2021）并注册临床试验（NCT06753058，日期12/30/2024）后，纳入450例年龄≥18岁、计划在腰麻下使用布比卡因加阿片类药物进行择期剖宫产的ASA II - III级产妇（n = 150，ERAS组；n = 300，对照组）。ERAS方案包括限制手术前后的禁食时间，术前2小时给予口服非颗粒性碳水化合物溶液（25克麦芽糊精），腰麻下术中多模式镇痛以及术后静脉注射10毫克甲氧氯普胺 + 1.5毫克格拉司琼预防恶心呕吐；术后镇痛采用静脉注射非甾体类抗炎药 + 对乙酰氨基酚。两组均提供母婴接触，ERAS组所有婴儿出生后尽快鼓励母乳喂养。记录两组产妇的禁食时间、排气、活动、拔除尿管时间、术后视觉模拟评分（VAS）、补救性镇痛需求、术后恶心呕吐（PONV）发生率、住院时间（LOS）、并发症、土耳其版产科恢复质量评分11（ObsQoR - 11T）。还记录新生儿人口统计学数据、阿氏评分、脐血气分析、营养和母乳喂养状况及并发症。
ERAS组的ObsQoR - 11T评分优于对照组（p < 0.001）。ERAS组产妇术前和术后禁食时间、术后首次排气和活动时间以及LOS、术后VAS、补救性镇痛需求均短于对照组（p < 0.001，p = 0.034，p < 0.001，p = 0.018，p < 0.001，p < 0.001），PONV发生率更低（p = 0.001）。两组之间的pH和pO有所不同。
我们认为，在ERAS路径中，使用ERAS在ObsQoR方面有利于实现更好的产妇恢复，在营养和母乳喂养方面有利于改善新生儿结局。
本研究根据https://www.biomedcentral.com/getpublished/editorial - policies#trial + registration上的说明进行回顾性注册临床试验（NCT06753058，于2024年12月30日09:19发布）。
