Comparison of a Modified Enhanced Recovery After Surgery Protocol with the Standard Protocol in Emergency Cesarean Deliveries: A Randomized Controlled Trial

Background: The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocol in elective cesarean deliveries (CD) is well established. Its applicability and safety in emergency CD remain unclear and require further investigation. Objective: This study aimed to evaluate postoperative recovery in pregnant women who underwent emergency CD. The recovery process was assessed using the Quality of Recovery questionnaire (QoR-35, Thai version) and pain scores measured by the Visual Analog Scale (VAS), comparing the modified ERAS (mERAS) protocol to the standard protocol. Materials and Methods: Fifty pregnant women were enrolled in a randomized controlled trial conducted at the medical education center of Phayao Hospital. The primary outcomes were the 24-hour QoR-35 score and the 48-hour VAS score. Additional parameters, including postoperative hospitalization duration, opioid use, and the onset of gastrointestinal functions, were also assessed. The analysis further considered postoperative complications such as fever, wound dehiscence, and readmission. Results: The mERAS group showed a significant reduction in 48-hour postoperative VAS scores (mean (SD): 4.0 (1.7) vs. 5.0 (1.3); mean difference: 1.0, 95% CI 0.14, 1.86, p = 0.024). No significant differences were observed between the two groups in assessments conducted at 24 hours or immediately postoperatively across all parameters. The mERAS group experienced shorter hospitalization (p = 0.017), earlier onset of burping (p = 0.049), and earlier onset of flatulence (p = 0.011). Neither group required additional opioid administration or experienced postoperative complications such as fever, wound dehiscence, or readmission. Conclusion: The implementation of a modified ERAS protocol effectively reduced VAS pain scores within 48 hours postoperatively, shortened hospitalization duration, and improved patient outcomes without increasing morbidity or surgical complications in patients undergoing emergency cesarean delivery.