# A Tailored Enhanced Recovery After Surgery (ERAS) Approach for Acute Pain Management in Elective Cesarean Deliveries: A Randomized Controlled Trial

## TL;DR

A tailored ERAS protocol for cesarean deliveries reduced postoperative pain, opioid use, and complications compared to standard care.

## Contribution

A tailored ERAS protocol was developed and tested for acute pain management in elective cesarean deliveries.

## Key findings

- The ERAS group had significantly lower intraoperative shivering and hypotension compared to the routine protocol group.
- Pain scores at 24 hours were significantly lower in the ERAS group during rest and movement.
- Opioid use was reduced in the ERAS group, with only 4% requiring opioids postoperatively versus 50% in the routine group.

## Abstract

Background

Cesarean delivery is a significant milestone in a mother’s life, often marked by joy. However, the postoperative period can be physically challenging, especially for those undergoing the procedure due to maternal or fetal indications.

Objectives

This study aimed to evaluate the effectiveness of a tailored enhanced recovery after surgery (ERAS) protocol in managing acute pain following elective cesarean deliveries. Traditional protocols often prolong maternal discomfort and delay recovery.

Methods

Eligible patients who provided written informed consent were randomized into two groups: the ERAS protocol (EP) group and the routine protocol (RP) group. Both groups underwent comprehensive preanesthetic evaluations, including history-taking, systemic examination, airway assessment, and standard blood investigations. Patients in the EP group were allowed to consume clear fluids up to two hours before surgery, whereas those in the RP group adhered to the conventional six-hour fasting protocol.

Results

Each group included 50 patients. Intraoperative shivering was significantly lower in the EP group (22.7%; five patients) compared to the RP group (77.3%; 17 patients) (p < 0.005). Hypotension occurred in 10 EP patients versus 32 in the RP group (p < 0.005). At 24 hours post-surgery, pain scores measured using the Visual Analogue Scale were significantly lower in the EP group both at rest (1.76 ± 0.82 vs. 2.96 ± 0.95) and during movement (2.46 ± 0.81 vs. 3.78 ± 0.89) (p < 0.005 for both). Opioid use was also markedly reduced in the EP group, with only two patients (4%) requiring opioids postoperatively, compared to 25 patients (50%) in the RP group (p < 0.005).

Conclusions

The tailored ERAS protocol significantly improved acute postoperative pain management in cesarean deliveries. Patients in the ERAS group experienced fewer intraoperative complications, reduced opioid consumption, faster mobilization, shorter hospital stays, and higher overall satisfaction.