A Tailored Enhanced Recovery After Surgery (ERAS) Approach for Acute Pain Management in Elective Cesarean Deliveries: A Randomized Controlled Trial

Background Cesarean delivery is a significant milestone in a mother's life, often marked by joy. However, the postoperative period can be physically challenging, especially for those undergoing the procedure due to maternal or fetal indications. Objectives This study aimed to evaluate the effectiveness of a tailored enhanced recovery after surgery (ERAS) protocol in managing acute pain following elective cesarean deliveries. Traditional protocols often prolong maternal discomfort and delay recovery. Methods Eligible patients who provided written informed consent were randomized into two groups: the ERAS protocol (EP) group and the routine protocol (RP) group. Both groups underwent comprehensive preanesthetic evaluations, including history-taking, systemic examination, airway assessment, and standard blood investigations. Patients in the EP group were allowed to consume clear fluids up to two hours before surgery, whereas those in the RP group adhered to the conventional six-hour fasting protocol. Results Each group included 50 patients. Intraoperative shivering was significantly lower in the EP group (22.7%; five patients) compared to the RP group (77.3%; 17 patients) (p < 0.005). Hypotension occurred in 10 EP patients versus 32 in the RP group (p < 0.005). At 24 hours post-surgery, pain scores measured using the Visual Analogue Scale were significantly lower in the EP group both at rest (1.76 ± 0.82 vs. 2.96 ± 0.95) and during movement (2.46 ± 0.81 vs. 3.78 ± 0.89) (p < 0.005 for both). Opioid use was also markedly reduced in the EP group, with only two patients (4%) requiring opioids postoperatively, compared to 25 patients (50%) in the RP group (p < 0.005). Conclusions The tailored ERAS protocol significantly improved acute postoperative pain management in cesarean deliveries. Patients in the ERAS group experienced fewer intraoperative complications, reduced opioid consumption, faster mobilization, shorter hospital stays, and higher overall satisfaction.