ABSTRACT
AIMS: Although most components of an enhanced recovery programme (ERP) can be applied to caesarean delivery, it is unknown if their implementation is large in France. TYPE OF STUDY: Structured interview by telephone or e-mailing of an anaesthetist to describe usual perioperative practice in two French regions (Provence - Alpes - Côte d'Azur [PACA] and Île-de-France [IDF]). METHODS: Questionnaire related to scheduled caesarean delivery. RESULTS: Response rate 74% (111/149 maternity units). Multimodal analgesia was almost universally applied and intrathecal/epidural morphine used by 86% of respondents. Oral administration of analgesic drugs was started before h24 in 50% of responding units and immediately after delivery in 7% of them. The urinary catheter was withdrawn after h24 in 71% of responding centres. Women were allowed to drink between h4 and h6 (60%), in an unlimited amount (79%). The first meal was authorised after h6 (89%) but before h24 (65%) or after recovery of bowel function (13%). Oxytocin was used in 69% of respondents and maintained postoperatively for 12 to 24hours (70% of oxytocin users). Carbetocin was used in the remaining 31%, usually without any maintenance oxytocic drug. Attributing one point to each major component of the ERP protocol (0-6), the median value was 3 (2-4). An ERP protocol was available in 14% of responding units and was associated with a shorter duration of intravenous and urinary catheters use. CONCLUSION: The study shows that the components of an ERP are insufficiently implemented in France after caesarean delivery. Moreover, significant heterogeneity exists between maternity units and among regions.
Subject(s)
Cesarean Section/rehabilitation , Perioperative Care/methods , Practice Patterns, Physicians'/statistics & numerical data , Analgesics/therapeutic use , Anesthesia Recovery Period , Anesthesia, Obstetrical/methods , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Drinking , Enteral Nutrition , Female , France , Health Care Surveys , Hospitals, Maternity/statistics & numerical data , Humans , Infant, Newborn , Interviews as Topic , Length of Stay , Oxytocin/therapeutic use , Pain, Postoperative/drug therapy , Patient Education as Topic , Perioperative Care/standards , Postpartum Hemorrhage/prevention & control , Pregnancy , Recovery of Function , Surveys and Questionnaires , Urinary Catheterization/statistics & numerical dataABSTRACT
We describe the case of two patients who had undergone gynecologic surgery and in whom a continuous ropivacaine infusion was administered through a catheter placed on each abdominal side, using the technique of ultrasound-guided TAP block. Postoperative analgesia was of excellent quality with almost no morphine requirement. No side effects were encountered.
