ABSTRACT
Introducci¨®n: La realimentaci¨®n progresiva no parece ser mejor tolerada que la realimentaci¨®n temprana y suele generar insatisfacci¨®n en las madres.Objetivo: Primario: Evaluar el nivel de satisfacci¨®n postoperatoria en pacientes sometidas a una operaci¨®n ces¨¢rea aquienes se les ofrece realimentaci¨®n temprana o realimentaci¨®n tradicional. Objetivos secundarios: evaluar la incidencia de s¨ªntomas de ¨ªleo, tiempo de retorno de ruidos hidro-a¨¦reos y de eliminaci¨®n de gases y dolor postoperatorio. Material y m¨¦todos: Ensayo cl¨ªnico aleatorizado. Se incluyeron todas las mujeres embarazadas cuyo parto fuese porces¨¢rea. Se excluyeron aquellas mujeres que presentaron: embarazos menores de 37 semanas, embarazo m¨²ltiple, uso de anestesia general, antecedentes de cirug¨ªa de intestino o lesi¨®n intestinal durante la ces¨¢rea, adherencias intra-abdominales,histerectom¨ªa puerperal, administraci¨®n de sulfato de magnesio o bloqueantes c¨¢lcicos, alguna condici¨®n m¨¦dica y/o quir¨²rgica que imposibilite la alimentaci¨®n temprana (diabetes). La intervenci¨®n consisti¨® en: Alimentaci¨®n temprana (AT): dieta general dentro de las primeras 8 h postoperatorias (m¨ªnimo de 400 Kcal). Alimentaci¨®n progresiva (AP): nada por boca en las primeras 0-4 h postoperatorias, dieta l¨ªquida 4-24 h y dieta general a partir de las 24 h postoperatorias hasta el alta hospitalaria. Dado que es un estudio de equivalencia, el an¨¢lisis se realiz¨® por tratamiento recibido. Resultados: Ciento tres mujeres fueron asignadas al grupo AP y 97 al grupo AT, en tanto 110 recibieron efectivamente AP y 90 AT. No hubo diferencias en las caracter¨ªsticas basales de los grupos. La media de satisfacci¨®n fue de 73,3 mm (IC95% 70,2-76,4) en la EAV (escala visual anal¨®gica) en el grupo AT (DS 16,5), y de 76,8 mm (IC 95% 74,0- 79,7) en el grupo AP (DS 13,6), con una diferencia entre grupos de -3,51 (IC 95% -7,80 0,77)...
Objective: To determine the equivalence of different patterns of postoperative feeding on the overall patient satisfaction or dissatisfaction with the process of care during postpartum hospital stay. Methods: A randomized, controlled study of equivalence was performed in which 97 patients were offered traditional feeding after c-section (nothing by mouth between 0 and 4 postoperative hours, then advanced to liquid diet between 5and 24 hours after surgery, and then fed with usual diet until discharge) and 103 patients were offered early feeding (solid food within 8 hours of surgery, with a minimum of 400 kcal) between December 15, 2003, and April 12, 2004, previous acceptation of a written informed consent. Both treatments were considered equivalent if the 95% confidence interval (CI) of difference between the means, was within the limits of -10 to +10 and contained the bound zero in both analyses, the as-treated as well as in the conservative intention-to-treat. The randomization occurred at the end of the surgery. Women were eligible for trial entry if they had a term pregnancy, irrespective of whether they had scheduled or intrapartum cesarean section performed under regional anthestesia. Women were excluded if they had any condition that precluded adherence to the planned intervention, if they received tocolytic drugs (magnesium sulfate, ¦Â2 agonists, calcium channel blockers), or general anesthesia. History of bowel surgery or intraoperative intestinal complications was also an exclusion criteria. Result: The preoperative and intraoperative base-line characteristics of these patients according to the assigned treatment were similar. Mean satisfaction was 73,3 mm (CI 95% 70,2-76,4) in the visual adjectival scale (VAS) in the traditional group (S.D. 16,5), and 76,8 mm (CI 95% 74,0-79,7) in the early feeding group (S.D. 13,6), with a difference betweengroups of -3,51 (CI 95% -7,80 0,77)...