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Table 1 Perioperative management in pre- and post-ERAS program in Caesarean deliveries practiced in Mongar Regional Referral hospital

From: The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay

Components Pre-ERAS Post-ERAS
Pre-operative
 • Fasting Overnight 6 h for solid and 2 h for clear liquid
 • Medication IV Ranitidine; IV Metoclopromide Oral Ranitidine and Antacid; Acetaminophen 1 g 2 h prior
 • Antibiobiotic prophylaxis IV Cephazolin 2 g within 1 h IV Cephazolin 2 g; Oral Azithromycin 1 g for laboring and/or membrane ruptured patients
 • Skin preparation Povidone iodine alone Alcohol-based Chlorohexidine or Iodine-Alcohol mixed-preparation
 • Vaginal preparation None Povidone iodine for all emergency cases
Intraoperative
 • Anaesthesia Neuraxial Neuraxial
 • Analgesia None LA infiltration of wound (subcutaneous) and IM PCM 600 mg
 • Hypothermia prevention None Forced air/ Temperature monitoring
 • Surgical procedure Blunt technique
Skin – Interrupted suture
Blunt technique
Re-approximation of subcutaneous layer if thickness > 2 cm
Skin – Subcuticular suture
 • Fluid management Liberal ~ 4 to 5 l first 24 h Goal directed, Early stopping of IV fluids
 • New born care Delayed cord cutting and early essential neonatal care not part of routine care Routinely done
Postoperative
 • Analgesia IM Pethidine and IM Diclofenac Intermittent IV Morphine for 24 h; Combination of Oral PCM and Ibuprofen started from 3 h
 • Feeding and parental fluid restricting Fasting for solid and liquid for 24 h Fasting for 3 h; Limited IV fluid
Normal diet as early as 6 h
 • Mobilization Not done until next day Routinely done after 6 h
Physiotherapy from day 1
 • Catheter removal Removed in postoperative day 1 Routinely removed after 6 h