title: [Evaluation of enhanced recovery for elective cesarean section].
abstract: OBJECTIVE
  To evaluate the implementation of a protocol of enhanced recovery for elective cesarean section in a level III maternity.
  
  
  METHODS
  This is a prospective observational study such as "before/after" on the implementation of a protocol of enhanced recovery for elective cesarean section from January 1st to December 31st, 2015, in a level III obstetrics unit French maternity. Patients were separated in 2 groups: women who benefit from enhanced recovery protocol after the first of July compared to women who underwent the conventional protocol between January 1st and June 30th, 2015. Inclusion criteria included: performing an emergency or scheduled cesarean, in patients with medical history congruent with the possible hospital release at day three. Demographic and obstetrics data were gathered. Items of the protocol, adverse and secondary effects as well as, postoperative complications were collected.
  
  
  RESULTS
  From January 1st to December 31st 2015, 408 patients were included in this study, 202 in the conventional arm protocol and 206 in the enhanced recovery protocol. Early rehabilitation protocol has been achieved for 25.7 % patients (n=105) with 18.1 % (n=19) before the establishment of the protocol and 81.9 % (n=86) after creation of the latter. Prevention of PONV by dexamethasone and droperidol was performed before and after creation of the protocol in 5.3 % (n=1) and 51.2 % of cases (n=44) (P<0.05), respectively. There were no significant differences between the 2 groups regarding the removal of the urinary catheter (94.7 % versus 76 %, P=0.14) or the shutter venous catheter SSPI (78.9 % vs 73 %, P=0.82). Administration of drinks H1 and H4 first meal were routinely performed after the creation of the protocol (52.6 % vs 100 %, P<0.05 and 63.1 % vs 100 %, P<0.05). An early rise in the first 12hours was usually performed after the drafting of the protocol (78.9 % versus 92 %, P<0.05). Average hospital stay was shorter after the establishment of early rehabilitation protocol (4 versus 5.5 days, P<0.05).
  
  
  CONCLUSIONS
  Early rehabilitation protocol was applied safely. It resolved in good management of pain, nausea and vomiting in postoperative. It participated in reducing adverse outcomes that could slow recovery and therefore allowed earlier hospital discharge, while maintaining high level of satisfaction with their care.
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Cattin
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: De Baene
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Département de gynécologie-obstétrique, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Achon
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bersot
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Destoop
authors.affiliation: Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Département de gynécologie-obstétrique, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Pelissier
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Département de gynécologie-obstétrique, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonneau
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Malinovsky
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Département de gynécologie-obstétrique, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Graesslin
authors.affiliation: Département d'anesthésie-réanimation, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Faculté de médecine, université de Reims-Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Département de gynécologie-obstétrique, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: eraimond@chu.reims.fr.
authors.forename: E
authors.initials: E
authors.lastname: Raimond
mesh_terms: D002585:Cesarean Section / Q000534:rehabilitation*; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D009325:Nausea / Q000517:prevention & control; D059408:Pain Management; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011446:Prospective Studies; D014839:Vomiting / Q000517:prevention & control
keywords: Cesarean; Césarienne; Enhanced recovery; Réhabilitation précoce