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