A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda.

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A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda.

Baluku M et al A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda. Anesth Analg. 2020 Mar;130(3):769-776. doi: 10.1213/ANE.0000000000004495.

What is already known:

This months ERAS reviews have an Obstetric theme. The other review was an RCT for elective caesarean section in a high income country. This one is the complete opposite and is an RCT for ERAS in emergency caesarean section in a resource limited setting of Uganda.

What this paper adds:

This is a great little study with 80 patients in each group. Patients were randomised into 2 groups. Considering it was only in patients undergoing emergency surgery, the ERAS group followed a fairly comprehensive ERAS pathway.

The ERAS group had a statistically shorter length of stay (18.5 hours shorter – p<0.001). Both groups underwent spinal anaesthesia but only the ERAS group had intrathecal morphine (normal standard care for these patients was to not use it). Unsurprisingly whilst rates of severe pain were significantly reduced (0 vs 9 p=0.001), rates of pruritis were significantly increased in the ERAS / IT Morphine group (16 vs 1 p=0.023).

This study nicely highlights that ERAS programmes can work for both emergency surgery and surgery in low-income countries.

Chris Jones, Guildford. @chrisnjones

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