Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery

Hedderson, Monique M.; Lee, Derrick; Hunt, Eric; Lee, Kimberly; Xu, Fei; Mustille, Alex; Galin, Jessica; Campbell, Cynthia I.; Quesenberry, Charles P.; Reyes, Vivian; Huang, Mengfei; Nicol, Barbara; Paulson, Shirley; Liu, Vincent

doi:10.1097/aog.0000000000003406

Cited by 80 publications

(80 citation statements)

References 22 publications

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“…Intrathecal dexmedetomidine (3 µg) do not prolong motor block duration. And early mobilization enhances postpartum recovery and shortens the period of hospitalization (Hedderson et al, 2019;Macones et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Zhang

et al. 2020

Front. Pharmacol.

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In this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section. Methods: Seventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 mg (RD3 group) and 5 mg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored. Results: The onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05). Conclusion: 3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia,

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Section: Discussionmentioning

confidence: 99%

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Zhang

et al. 2020

Front. Pharmacol.

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“…Enhanced recovery after surgery (ERAS) is a philosophy of perioperative care that has been utilized in other fields since the 1990s, yet only recently has been applied to obstetric care. [1][2][3][4][5][6][7] In various subspecialties, ERAS protocols have been shown to achieve the triple aim: increasing patient satisfaction, decreasing cost, and improving quality. 8 As key maternity care stakeholders seek to improve care quality and costs, ERAS may be a promising solution for addressing value in the postpartum period.…”

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confidence: 99%

Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

et al. 2020

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Objective The aim of this study is to assess the effect of a resident-led enhanced recovery after surgery (ERAS) protocol for scheduled prelabor cesarean deliveries on hospital length of stay and postpartum opioid consumption. Study Design This retrospective cohort study included patients who underwent scheduled prelabor cesarean deliveries before and after implementation of an ERAS protocol at a single academic tertiary care institution. The primary outcome was length of stay following cesarean delivery. Secondary outcomes included protocol adherence, inpatient opioid consumption, and patient-centered outcomes. The protocol included multimodal analgesia and antiemetic medications, expedited urinary catheter removal, early discontinuation of maintenance intravenous fluids, and early ambulation. Results A total of 250 patients were included in the study: 122 in the pre-ERAS cohort and 128 in the post-ERAS cohort. There were no differences in baseline demographics, medical comorbidities, or cesarean delivery characteristics between the two groups. Following protocol implementation, hospital length of stay decreased by an average of 7.9 hours (pre-ERAS 82.1 vs. post-ERAS 74.2, p < 0.001). There was 89.8% adherence to the entire protocol as written. Opioid consumption decreased by an average of 36.5 mg of oxycodone per patient, with no significant differences in pain scores from postoperative day 1 to postoperative day 4 (all p > 0.05). Conclusion A resident-driven quality improvement project was associated with decreased length of hospital stay, decreased opioid consumption, and unchanged visual analog pain scores at the time of hospital discharge. Implementation of this ERAS protocol is feasible and effective. Key Points

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“…Moreover, we used a pain scale from zero to 10 and were assessed at two, six, and 12 hours after surgery. While in the study of L. Renfro et al [16], the patients were assessed at rest, six, 12,18,24,30,36,42, and 72 hours, although they used the same VAS. Furthermore, our study is similar to the study of L. Renfro et al [16], who involved a multi model pain regimen that initiated immediately after the delivery of the baby.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, ERP has a triple aim; improving quality of care, increase patient satisfaction, and decreasing the costs [10]. The purpose of the program is to optimize patients' perioperative care by accelerating the patients' recovery to normal physiological state [6][7][11][12]. Also, the ERP pathway is the concept of enhancing and improving recovery from the catabolic and inflammatory body responses to surgery [2].…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery Program after Cesarean Section in Sulaimani Maternity Teaching Hospital

Mohammed

Jawad

Murad

2020

KJAR

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Enhanced recovery program (ERP) for cesarean section (C/S) is improving patient health and is cost-effective for healthcare providers. We aimed to assess how ERP improves patient satisfaction, ambulation time, severity of pain, decrease hospital stay among patients attending Sulaimani Maternity Teaching Hospital and fetal outcome. A quasi-experimental study was performed on 200 patients in Sulaimani from June 2019 to December 2019. The participants divided into two equal groups. The intervention group was 100 women who underwent elective C/S in Sulaimani Maternity Teaching Hospital and subjected to ERP. While the control group was the other 100 women who were not subjected to the ERP, and they were from the Emergency Department of the same hospital. The women in the intervention group were supervised by anesthetists from preoperatively, intraoperatively, through postoperatively. The intervention group showed significantly better outcome regarding time to ambulate; all patients were able to ambulate 4-5 hours postoperatively. Also, the duration of hospital stay was better in the intervention group; all the patients discharged before 24 hours, but five patients in the control group discharged after 24 hours. Besides, fetal Apgar score after five minutes was also better in the intervention group; at the first minute, the mean±SD (standard deviation) of Apgar score was 8.36±1.38 and 8.08±1.69 for the intervention, and control groups, respectively (P-value = 0.2). While at five minutes, the mean±SD of Apgar score was 9.59±064, and 8.96±1.12 for the intervention, and control groups, respectively (P-value = <0.001). This intervention had favorable outcomes regarding pain, time of ambulation, and fetal Apgar score. We recommend implementing ERP at a broader scale as it gives better outcomes.

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Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 80 publications

References 22 publications

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative

Enhanced Recovery Program after Cesarean Section in Sulaimani Maternity Teaching Hospital

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