[Postoperative management after cesarean section--infusion therapy and role of intestinal stimulation with parasympathomimetic drugs and dexpanthenon].

In the last decade the incidence of cesarean section has raised worldwide to 15-30% of all deliveries. A standardized postoperative protocol can be applied to most cases and it should be easy to handle and at low costs. In the present randomized, prospective study 76 consecutive patients who hat a cesarean section were investigated. Two different infusion therapy protocols were compared and the role of prophylactic stimulation of peristalsis by parasympathometic drugs and by the pantothenic acid derivative dexpanthenon was evaluated. In group A patient (n = 36) were treated postoperatively with intravenous glucose 5% plus electrolytes and received routinely neostigmine and dexpanthenon, while patients in group B (n = 40) were treated with standardized commercially available solutions without intravenous stimulation of the bowel. Both groups were similar in terms of age, parity, gestational age, past medical history and previous abdominal surgery. The volume of urine and the serum electrolyte levels were similar in both groups postoperatively. The first evacuation of the bowel occurred in most cases on day 3 (A = 69.5%, B = 82.5% of the patients). 50% of the patients in group A complained of abdominal discomfort and pain postoperatively and needed some therapy, while in group B only 22.5% of the cases hat similar complaints. This difference was statistically significant (chi 2 Test: p < 0.02). The present data suggest that prophylactic postoperative stimulation of the peristalsis after cesarean section increases the incidence of abdominal discomfort significantly without influencing the bowel function. Standardized solutions can be used mostly for immediate intravenous fluid replacement and oral intake can be started after 2-6 hours.