Practice of Enhanced Recovery after Caesarean Delivery: A Randomised Controlled Clinical Trial in a Tertiary Hospital in Yaoundé-Cameroon

Abstract

Background: Enhanced recovery after surgery (ERAS) is a new and evolving concept whereby strategies are put in place in the perioperative period to ensure better and accelerated patient recovery with fewer complications. Being a new protocol in our milieu, the need for pre-implementation trials motivated our study in elective caesarean section (CS) in the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH). Aims: To analyse the benefits of the enhanced recovery after caesarean section program (ERAS) over standard care in women undergoing elective caesarean section in the Yaoundé Gyneco – Obstetric and Paediatric Hospital. Materials and Methods: A single-blinded randomized controlled trial, in the ratio 1:1, from December 2020 to August 2021, compared the ERAS in caesarean section (ERAS-CS) treatment package, with our standard care package (Non-ERAS group). The ERAS-CS package included pre-operative counselling, reduced pre-operative fast, warming of fluids intraoperatively, use of Dexamethasone and Ondansetron (to prevent post-operative nausea and vomiting) and early oral feeding as well as early mobilisation. Satisfaction 24 hours after surgery as well as complications were evaluated in both groups. Data analysis was with STATA. Results: We enrolled 42 women, 21 in each arm. Average age of participants was 31.9 years. A body temperature drop of 0.6 degree Celsius in the ERAS group versus 1.7 degree Celsius in N-ERAS group, p=0.001 was noted. Intraoperative nausea and vomiting (IONV) was significantly decreased in the ERAS group (p=0.038) as well as per-operative hunger and cold. ERAS patients felt significantly more capable of looking after their personal toileting and hygiene, and in control with a greater feeling of well-being than those in the N-ERAS group, 24 hours after surgery. Conclusion: The ERAS-CS program led to fewer per and post-operative complications, and faster recovery of patients.