Recovering from surgery is tough on anyone, but for a mom who’s trying to care for a brand-new baby – it’s a more challenging scenario than most. Plus, managing pain after a surgical procedure often involves the use of narcotics – which isn’t an ideal situation for a breastfeeding mom or a newborn baby.
That’s why Lisa Grana, MD, (Triangle Physicians for Women), who delivers babies at WakeMed Cary Hospital, brought forth the idea to implement an ERAS protocol for patients undergoing elective C-section procedures.
Reducing Surgical Stress for Patients
ERAS, which stands for enhanced recovery after surgery, is an emerging model used around the world to help reduce a patient’s surgical stress response, optimize their physiologic function and facilitate a faster recovery. It’s an evidence-based care pathway that includes a series of pre-op, intra-op and post-op activities that, when combined, lead to better outcomes and faster recovery. It’s a simple, yet powerful model that’s having a significant impact on our patients’ experience.
WakeMed uses the ERAS model for cardiac surgery as well and has been nationally recognized as the first U.S. hospital to implement this protocol.
ERAS for C-Section Patients
For C-section patients, these steps include:
- Drinking a carbohydrate drink such as Powerade/Gatorade three hours before surgery
- Chewing gum shortly after surgery to decrease nausea and promote bowel function
- Getting up and moving more quickly after surgery
- Having the patient’s catheter removed sooner
Most notably, ERAS includes modifications to traditional pain management protocols – and includes the use of a combination of medications designed to treat swelling and pain with less opioid use.
“With the growing concern for the opioid epidemic, I had been looking at options for reducing the use of narcotics for my surgical patients,” explains Dr. Grana. “I’d heard of ERAS for colorectal and other GYN surgeries, so I started scouring the literature for data on C-sections. I found a growing body of evidence from across the world supporting this approach for elective C-sections, so I brought it to the Cary Hospital OB/GYN department for consideration. The overwhelming response was to move forward with developing the protocols and implementing the pathway.”
System-Wide Implementation of ERAS
Cary Hospital went live with ERAS for elective C-sections in April 2019 and the Raleigh Campus and North Hospital followed suit in October with our system-wide implementation.
“Since implementation, we’ve already seen incredible results – including a significant reduction in our opioid use and overwhelmingly positive patient feedback,” explains Angela Newman, RN, director, Cary Hospital Women’s Pavilion & Birthplace. “Moms who have had multiple c-sections can’t believe how different their recovery is with ERAS and they are so relieved to feel better more quickly so they can better care for their families.”
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