Enhanced recovery after surgery ppt.pptx

Eras powerpoint presentation

1. EVIDENCE BASED STUDY OF ENHANCED RECOVERY AFTER CESAREAN SECTION OF ELECTIVE CASES IN OUR TERTIARY HEALTH CARE CENTRE” dr.Vrushali c. tarmale GUIDE- DR VIDYA TIRANKAR Dr.vijay pawar vmgmc solapur

2. Introduction India has exceeded Caesarean delivery rate above WHO recommendations with absolute as well as nonessential indications too due to lack of required facilities. The Early Recovery After Surgery (ERAS) protocol has been implemented in several specialty to speed up the recovery time following cesarean delivery which will minimize the duration of hospital stay and also cost. ERAS protocol was first initiated by Professor Henrik Kehlet in the 1990s for colorectal surgery. Later on it was implemented in other surgical branches too.

3. Key components

4. AIMS AND OBJECTIVES AIM To test whether the implementation of enhanced recovery after surgery (ERAS) protocol for patients undergoing elective Cesarean delivery has a positive impact on the post-operative status of the patients in terms of maternal and neonatal outome . OBJECTIVES Length of hospital stay, Decrease in major morbidity, Post-operative recovery Reduction of surgical stress response and Cost effectiveness

5. METHODOLOGY TYPE : PROSPECTIVE OBSERVATIONAL STUDY SAMPLE SIZE : CASES -50 CONTROL -50 DURATION : 1 YEAR , 2022 TO 2023 Each case will be assessed on the basis of prefixed parameters on a pre-formulated detailed questionnaire.

6. Inclusion criteria: All pregnant women scheduled for elective cesarean section without any co-morbidities. Those mothers willing to give consent. Exclusion criteria: All pregnant women requiring termination of pregnancy on emergency basis. Pregnant women having medical and obstetric co-morbidities like PIH/ severe pre-eclampsia/ eclampsia, gestational diabetes/ overt diabetes, thyroid dysfunction, underlying heart disease, abruption placenta, placenta previa, IUD, fetal distress, cord prolapse. Patients divided into 2 groups : Group A -50 [ERAS] Group B - 50 [standard conventional protocol]. .

7. DATA EXTRACTION AGE GROUP TEST GROUP CONTROL GROUP <21 YEARS 5 4 20-25 YEARS 13 13 25-30 YEARS 5 5 >30 YEARS 2 3 TOTAL 25 25 CASES CONTROLS PRIMIGRAVIDA 8 8 PREVIOUS LSCS 10 10 PREVIOUS 2 LSCS 4 5 MULTIGRAVIDA 3 2 TOTAL- 40 25 25 PARITY

8. PRE OPERATIVE NBM STATUS CARBOHYDRATE LOADING 2 HOURS PRIOR TO SURGERY NBM PEROID CASES CONTROL SOLID FOODS 6HOURS 25 23 2-6 HOURS 2 0-2HOURS LIQUIDS 6HOURS 25 2-6 HOURS 0-2HOURS 25 CASES CONTROLS DONE 25 25 NOT DONE TOTAL 25 25

9. TAP BLOCK-TRANSVERSUS ABDOMINIS PLANE BLOCK NEED FOR RESCUE ANALGESIA CASES CONTROLS GIVEN 25 NOT GIVEN 25 TOTAL 25 25 CASES CONTROLS WITHIN 1 HOUR OF SURGERY 2 19 WITHIN 6 HOURS OF SURGERY 3 6 NONE 20 TOTAL 25 25

10. EARLY NBM OUT NBM OUT TIME CASES CONTROL 2 HOURS AFTER SURGERY 21 2-6 HOURS AFTER SURGERY 1 2 >6HOURS AFTER SURGERY 3 23 EARLY MOBILISATION CASES CONTROL WITHIN 2 HOURS OF SURGERY 22 2-6HOURS AFTER SURGERY 2 2 >6HOURS AFTER SURGERY 1 23

11. BREAST FEEDING INITIATION PEROID DURATION OF STAY IN HOSPITAL CASES CONTROL WITHIN 2 HOURS 27 21 2-6 HOURS 3 4 AFTER 6 HOURS TOTAL 25 25 CASES CONTROL EARLY DISCHARGE 23 4 PROLONGED STAY 2 21

12. Comparison of post-operative complication between nonERAC and ERAC group

13. Conclusion 1. The present study has compared the use ERAC protocol with non-ERAC in our setting. . 2. The post-operative pain and duration of hospital stay was lesser in ERAC group than non-ERAC. 3. Moreover patient satisfaction with ERAC was also better. Thus implementing ERAC in our setting will prove to be beneficial to the patients. REFERENCES Moningi , Srilata et al. “Enhanced recovery after surgery: An anesthesiologist's perspective.” Journal of anaesthesiology, clinical pharmacology vol. 35,Suppl 1 (2019): S5-S13 • Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289-334

14. Thank you .