Mayang Indah Lestari, Djayanti Sari, Susilo Chandra, Purwoko Purwoko, Isngadi Isngadi, Tungki Pratama Umar
Background and Aims: Enhanced recovery after cesarean (ERAC) is an interdisciplinary approach to improve patient outcomes following cesarean section. ERAC’s execution must be constantly evaluated. Thus, we aimed to analyze parameters associated with ERAC adoption for clinical care in this expanded systematic review. Material and Methods: A systematic literature search using Epistemonikos, Google Scholar, PubMed, and Scopus was done until February 2023. The appropriate observational and experimental research comparing the effects of ERAC protocols with conventional care on postoperative adverse events, operation-related characteristics, time to first (oral intake, mobilization, bowel movement, and urinary catheter removal), and opioid use. Meta-analyses were conducted using the RevMan 5.4.1. and Comprehensive Meta-Analysis version 3.3 software. Results: In total, 23 studies were included in this systematic review. ERAC implementation was found to be associated with improvement in terms of shorter postoperative hospital stays and faster time to first liquid intake, first solid diet, urinary catheter removal, and mobilization. Furthermore, the rate of opioid-free treatment, total in-hospital morphine milligram equivalent (MME), daily in-hospital MME, and total prescribed opioid pills at discharge (all parameters, P < 0.01) were significantly better in the ERAC group than in the conventional care group. However, no significant difference was observed regarding postoperative adverse events, blood loss, operation duration, and total prescribed MME at discharge parameters between the two observed groups. Conclusion: ERAC implementation is associated with better healthcare delivery, as determined by shorter time to first, lower opioid consumption, and shorter postoperative length of stay compared with conventional care. However, it is not associated with a lower dosage of opioid prescription at discharge. © 2024 Journal of Anaesthesiology Clinical Pharmacology.
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya, Dr. Mohammad Hoesin General Hospital, Siti Fatimah Hospital, South Sumatera, Palembang, Indonesia; Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/RSUP Dr. Sardjito, Yogyakarta, Indonesia; Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, Indonesia; Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Negeri Sebelas Maret/RSUD Dr. Moewardi, Central Java, Surakarta, Indonesia; Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Brawijaya/RS Dr. Saiful Anwar, East Java, Malang, Indonesia; Division of Surgery and Interventional Science, University College London, London, United Kingdom; Medical Profession Program, Faculty of Medicine, Universitas Sriwijaya, South Sumatera, Palembang, Indonesia
