Enhanced Recovery After Surgery (ERAS) Protocol Versus Standard Care in Elective Cesarean Delivery: A Prospective Randomized Controlled Trial

Objective: Enhanced recovery after surgery (ERAS) protocols are designed to accelerate postoperative recovery, improve maternal comfort, and reduce complications in cesarean deliveries.Evidence regarding their effectiveness in elective cesarean sections in our country remains limited. Methods:This prospective, open-label, randomized controlled trial was conducted at our hospital between October and December 2022.A total of 84 pregnant women (≥37 weeks, American Society of Anesthesiologists physical status I-II) scheduled for elective cesarean delivery were randomized equally to either the ERAS protocol (n=42) or standard care (n=42).The primary outcome was the 24-hour postoperative visual analog scale (VAS) pain score.Secondary outcomes included 48-hour VAS score, time to first passage of flatus, and postoperative nausea.Time to oral intake and time to first mobilization were recorded as process measures reflecting protocol adherence.Results: As expected from the ERAS protocol design, oral intake [4.00 h (4.00-5.00) vs. 13.00h (11.00-14.75)]and mobilization [4.00 h (4.00-5.00) vs. 6.00 h (5.00-6.00)]occurred significantly earlier in the ERAS group (p<0.001),reflecting protocol adherence rather than independent clinical effects.The ERAS group also experienced earlier breastfeeding initiation [3.00 h (2.00-4.00) vs. 5.00 h (4.00-6.00),p<0.001] and earlier first passage of [7.00 h (6.00-9.00) vs. 13.00h (11.00-15.00),p<0.001].Pain scores were significantly lower in ERAS patients at 24 hours [3.50 (2.00-4.00) vs. 6.00 (5.25-7.00)]and 48 hours [1.00 (1.00-2.00) vs. 3.00 (2.00-3.25)](p<0.001).Postoperative nausea rates were comparable between groups (11.9% vs. 16.7%,p=0.755), and no major complications occurred. Conclusion:The ERAS protocol for elective cesarean delivery significantly accelerates functional recovery, reduces postoperative pain, and facilitates earlier breastfeeding without increasing complications.