Impact of Multimodal Enhanced Recovery after Cesarean Delivery Protocol Including Transversus Abdominis Plane Block on Postoperative Pain and Recovery after Cesarean Deliveries: An Experience at a Tertiary Hospital in South India

Aim: The study aims to compare postoperative pain and recovery with a tailored multimodal Enhanced Recovery after Cesarean Delivery (mERCD) protocol and conventional postoperative management protocol after elective cesarean delivery. Materials and methods: This prospective cohort study involved women undergoing elective cesarean delivery. One group of women received the new multimodal ERCD (mERCD) protocol, and the other group, conventional management. The mERCD group had transversus abdominis plane (TAP) block, gum chewing, early oral initiation, and urinary catheter removal. The conventional group received standard analgesia, started on orals, and had catheter removal at 24 hours. We compared postoperative pain and recovery between the groups at 6 and 24 hours using a visual analog scale (VAS) and predefined variables assessing recovery. Results: Pain scores at rest in mERCD group and the conventional group were 4.20 and 6.19 at 6 hours (p = 0.005) and 3.71 and 4.1 at 24 hours (p = 0.018). Respective pain scores with the movement were 4.84 and 6.35 (p = 0.005) at 6 hours and 3.74 and 4.91 at 24 hours (p = 0.005). Return of bowel sounds at 6 hours was 100% and 123 (82%) in mERCD and conventional groups, respectively (p = 0.005). In mERCD group, 49 (70%) passed flatus at or before 24 hours, whereas in the conventional protocol group, the same it happened before 24 hours in 84 (56%) (p = 0.04). There was no significant difference in the time taken to pass urine after catheter removal; the mERCD group had higher satisfaction scores 7.02 SD 1.16 than 4.05 SD 1.06 in the conventional group (p = 0.005). Conclusion: Multimodal Enhanced Recovery after Cesarean Delivery protocol effectively improved women’s postoperative experience by providing good analgesia and enhancing early recovery. Clinical significance: Hospitals must adopt a tailored multimodal early recovery after surgery (ERAS) approach to enhance postoperative recovery after cesarean delivery.