title: [Enhanced recovery following uncomplicated elective caesarean section in France: a survey of national practice].
abstract: BACKGROUND
  Enhanced recovery is a concept currently recognised and adopted in a number of surgical specialties. In obstetrics however, this concept remains surprisingly underdeveloped. The purpose of this survey was to study the practice of obstetric anaesthetists in France as regards the recovery of women undergoing uncomplicated, elective caesarean section.
  
  
  METHODS
  An online 39-point questionnaire was displayed for 2months on the Caro (Club d'anesthesie réanimation en obstétrique) website. The questionnaire related to uncomplicated, elective Caesarean sections and aimed to define the following: preoperative information given regarding the recovery period, intraoperative care - both anaesthetic and surgical, postoperative analgesia, measures taken to prevent post-partum haemorrhage, reintroduction of fluids and diet, return to mobility, local practices designed to promote bonding between mother and baby.
  
  
  RESULTS
  The overall response rate for our survey was 45%. Forty-nine percent of practitioners report that patients are provided with specific information on the recovery period preoperatively. Sixty percent of those surveyed state the absence of any specific recovery protocol for this patient population in their hospital. Eighty-one percent of respondents state that, in the majority of cases, patients are admitted on the eve of surgery and remain hospitalised for more than 72hours (89%). Ninety-nine percent of practitioners employ a regional technique to deliver anaesthesia for elective section and 44% rely on intrathecal morphine for postoperative analgesia. The concept of 'Patient Controlled Oral Analgesia' (PCOA), although widely recognised, is used by only 17% of practitioners. Forty-one percent of practitioners report the reintroduction of fluids as soon as patients return to the ward following surgery and at the same time as the urinary catheter is removed (51%). Diet is commenced 4 to 6hours following surgery amongst 40% of those surveyed. Fifty-one percent of practitioners report removal of the intravenous catheter 24hours postoperatively. Finally, 49% of practitioners feel patients are independently functioning and mobile within 24hours of surgery.
  
  
  CONCLUSIONS
  This survey of national practice shows that the concept of 'enhanced recovery' following elective caesarean section can be again developed. Standardisation of practice with the design of local protocols relating to postoperative analgesia, timing of removal of the intravenous access and urinary catheter, time to first mobilisation and to commencement of diet would appear to be warranted. Surely this surgery, more than any other, merits an expeditious and effective return to normal and independent function, allowing mother to better look after baby.
authors: Service d'anesthésie-réanimation, maternité régionale, 10, rue Docteur-Heydenreich, 54000 Nancy, France. valjacques@orange.fr
authors: V
authors: V
authors: Jacques
authors: F
authors: F
authors: Vial
authors: M
authors: M
authors: Lerintiu
authors: N
authors: N
authors: Thilly
authors: U
authors: U
authors: Mc Nelis
authors: J
authors: J
authors: Raft
authors: H
authors: H
authors: Bouaziz
mesh_terms: D016058:Analgesia, Patient-Controlled; D000762:Anesthesia Recovery Period; D000773:Anesthesia, Obstetrical / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002585:Cesarean Section / Q000534:rehabilitation*; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D004750:Enteral Nutrition; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D009020:Morphine / Q000627:therapeutic use; D009034:Mother-Child Relations; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D010353:Patient Education as Topic; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014546:Urinary Catheterization
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D009020:Morphine