The following review focuses on routine postoperative care after cesarean delivery (CD), including specific Enhanced Recovery After Cesarean (ERAS) recommendations as well as important postpartum counseling points. Following CD, there is insufficient evidence to support administration of prophylactic multi-dose antibiotics to all patients. Additional antibiotic doses are indicated for the following scenarios: patients with obesity, CD lasting ≥ 4 hours since prophylactic dose, blood loss >1,500 mL, or those with an intra-amniotic infection. An oxytocin infusion for prevention of postpartum hemorrhage should be continued post-CD. While initial measures to prevent postoperative pain occur in the intraoperative period, with the consideration of 1g intravenous (IV) acetaminophen and IV or intramuscular (IM) non-steroidal anti-inflammatory medications (e.g., 30mg IV ketorolac), the focus postoperatively continues with this multimodal approach with scheduled acetaminophen per os (PO, 650mg every 6 hours) and non-steroidal agents (ketorolac 30mg IV every 6 hours for 4 doses followed by ibuprofen 600mg PO every 6 hours) being recommended. Short-acting opioids should be reserved for breakthrough pain. Low-risk patients should receive mechanical thromboprophylaxis until ambulation with chemoprophylaxis being reserved for patients with additional risk factors. When an indwelling bladder catheter was placed intraoperatively for scheduled CD, it should be removed immediately postoperatively. Chewing gum to aid in return of bowel function and early oral intake of solid food can occur immediately after CD and within 2 hours, respectively. For prevention of postoperative nausea and vomiting, administration of 5HT antagonists in recommended with the addition of either a dopamine antagonist or a corticosteroid as needed based on non-cesarean data. Early ambulation after CD starting 4 hours postoperatively is encouraged and should be incentivized by pedometer. For patients that receive a dressing over the CD skin incision, there is limited evidence regarding when best to remove it. Adjunct non-pharmacologic interventions for postoperative recovery discussed in this review are acupressure, acupuncture, aromatherapy, coffee, ginger, massage, reiki and TENS. In the low-risk patient, hospital discharge may occur as early as 24-28 hours if close (i.e., 1-2 days) outpatient neonatal follow up is available due to the potential for neonatal jaundice; otherwise, patients should be discharged at 48-72 hours postoperatively. Upon discharge, the multimodal pain control recommendations of acetaminophen and ibuprofen should be continued. If short-acting opioids are necessary, the prescribing practices should be individualized based upon the inpatient opioid requirements. Other portions of postoperative/postpartum counseling during the inpatient stay include the optimal interpregnancy interval of 18 to 23 months, encouraging exclusive breastfeeding for at least 6 months, quick resumption of physical activity and vaginal intercourse guidance as tolerated. Patients should also be counseled pre-CD on the option of immediate postpartum IUD insertion, intraoperative salpingectomy or placement of long acting reversible contraception in the postpartum period. Implementation of such evidence-based postoperative care protocols decrease length of stay, surgical site infection rates, and improve patient satisfaction and breastfeeding rates.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.ajogmf.2024.101549 | DOI Listing |
Hinyokika Kiyo
November 2024
The Department of Urology, Kitasato University School of Medicine.
We carefully reviewed and evaluated the efficacy of transurethral water vapor energy therapy (WAVE) with Rezumᵀᴹ system for treatment of benign prostatic hyperplasia. Between April and September 2023, 41 patients received WAVE under local anesthesia as day surgery at the outpatient department in our institution. The mean age as of operation was 78.
View Article and Find Full Text PDFBMC Surg
December 2024
Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.
Background: Biliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians.
Objective: This study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center.
Methods: A retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021.
BMC Surg
December 2024
Department of Gynecology, Maternal & Child Health Center Of Dezhou, No. 835 Dongdi middle Avenue, Decheng District, Dezhou, China.
To evaluate the impact of open surgical care (OSC) compared to minimally invasive surgery (MIS) on the occurrence of wound infection (WI) and overall postoperative aggregate complications (POACs) in female cervical cancer (CC) patients, we conducted this meta-analysis study. A thorough examination of the literature up to March 2024 was conducted, and 1849 related studies were examined. The 44 studies that were selected included 11,631 females who had CC.
View Article and Find Full Text PDFSemin Oncol Nurs
December 2024
College of Nursing, Research Institute of Nursing Innovation, Kyungpook National University, Daegu, South Korea. Electronic address:
Objectives: This article aims to investigate the effects of a postoperative dietary intervention on fatigue, self-efficacy in managing gastrointestinal side effects, self-efficacy for nutritional management, self-care activity, and unmet nursing needs among patients with gastric cancer who have undergone gastrectomy.
Methods: We used a quasi-experimental study design (nonequivalent control group pretest-posttest). Data were collected from 59 patients with gastric cancer (30 in the experimental group and 29 in the control patients) hospitalized for gastrectomy in Daegu, South Korea.
J Chest Surg
December 2024
Department of Upper GI Surgery, Salford Royal Foundation Trust, Northern Care Alliance, Salford, UK.
Postoperative chylothorax is a serious complication after oesophagectomy. Real-time identification of the thoracic duct (TD) could prevent injury or facilitate prompt management when it occurs. Intraoperative TD lymphography with indocyanine green (ICG) is a novel technique that may help prevent chyle leaks following thoracic surgery.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!