Comparison of a Modified Enhanced Recovery After Surgery Protocol With the Standard Protocol in Emergency Cesarean Deliveries: A Randomized Controlled Trial

Background: The study investigated the effectiveness of a modified enhanced recovery after surgery (mERAS) protocol in emergency cesarean deliveries (CDs), where its safety and applicability remain uncertain. Postoperative recovery was evaluated in pregnant women using the Thai version of the Quality of Recovery-35 (QoR-35) questionnaire and pain scores measured by the Visual Analogue Scale (VAS). Methods: 50 pregnant women were enrolled in a randomized controlled trial conducted at the Medical Education Center of Phayao Hospital. The primary outcomes were the 24-hour QoR-35 score and the 48-hour VAS pain score. Additional parameters, including postoperative hospital stay, opioid use, and the onset of gastrointestinal function, were also assessed. Postoperative complications, such as fever, wound dehiscence, and readmission, were also evaluated. Results: The mERAS group showed a significant reduction in 48-hour postoperative VAS scores (mean ± standard deviation [SD]: 4.0 ± 1.7 vs. 5.0 ± 1.3; mean difference: 1.0, 95% confidence interval [CI] 0.14, 1.86, p = 0.024). No significant differences were observed between the two groups in assessments conducted immediately postoperatively or at 24 hours across all parameters. The mERAS group experienced shorter hospital stays (p = 0.017), earlier onset of burping (p = 0.049), and earlier onset of flatulence (p = 0.011). Neither group required additional opioid administration or experienced postoperative complications, such as fever, wound dehiscence, or readmission. Conclusions: Implementation of the mERAS protocol effectively reduced 48-hour postoperative VAS pain scores, shortened hospital stay, and improved patient outcomes without increasing morbidity or surgical complications in patients undergoing emergency CD. Clinical Trial Registration: The study has been registered on https://www.thaiclinicaltrials.org/ (registration number: TCTR20250627001; registration link: https://www.thaiclinicaltrials.org/export/pdf/TCTR20250627001).