Liby Varughese, RN, DNP, CRNA

DNP Nurse Anesthesia

Evaluation of the Adherence to Anesthesia Practices for Enhanced Recovery After Cesarean Delivery Recommendations

Project Category: Evidence Implementation  

Project Team: Liby Varughese, DNP, CRNA, Leticia Gomez, DNP, CRNA, Nancy Garcia, DNP, CRNA,  Jennifer Greenwood, PhD, CRNA; Kristale Privette, DNP, CRNA; Brooke Williams, DNP, CRNA (Advisors)

Abstract

Background: Enhanced Recovery after Cesarean delivery (ERAC) programs are designed to incorporate evidence-based practices and multimodal analgesia to improve patient recovery and reduce opioid use. However, many hospitals do not have an established ERAC protocol. An  evaluation of anesthesia-related practices utilizing ERAC recommendations can help improve patient outcomes.

Methods: Retrospective data was collected from the electronic health records of 80 elective cesarean patients. Anesthesia-related practices were evaluated against best practice ERAC recommendations and their impact on inpatient opioid use in morphine milliequivalents (MME) and postoperative (postop) mean maximum pain scores. Groups were categorized based on the number of ERAC parameters received: group A, 6-9 parameters; group B, 10-11; and group C, 12-13. Outcomes were compared amongst the three groups.

Results: There were no statistically significant differences in pain scores and MME consumption. Group C had the lowest pain scores one-hour postop (0.14, ±0.378), and group B had the lowest pain scores at discharge (3.07, ± 2.847). Group A had the lowest pain scores in the first 24-hrs (3.82, ± 1.976) and the second 24-hrs (4.82, ±2.834). Secondary analysis showed that intrathecal (IT) morphine significantly impacted pain scores (8.67 ± 1.528 vs. 4.25 ± 0.50, p = 0.032) and intraoperative MMEs (1.01 ± 2.974 vs. 8 ± 7.467, p = 0.005).

Conclusion: This investigation uncovered practice variations and low adherence rates with several ERAC elements, such as intraoperative ketorolac and multimodal anti-emetics. Future work could aim to establish more consistent practices, greater adherence to best practice recommendations, and implementation of a formal ERAC protocol.