Pain score and quality of post cesarean section recovery with ERACS method

Background : A cesarean section must be done when regular childbirth is impossible owing to fetal or maternal health issues. One of the complications of cesarean section is pain and quality of recovery. The strategy for managing pain and quality of recovery is using the ERACS method. This method is a new technique in anesthesia with the principles of

A cesarean section is a medical technique used to help childbirth when it is unable to do so naturally because of the mother's health or the fetus's condition. This treatment is described as either a hysterotomy to deliver the fetus from within the uterus or surgery to deliver the fetus by opening the abdominal wall, uterine or vaginal walls (1). Data (4). Along with the increasing public interest in cesarean section, perioperative services have also increased. To increase the clinical benefits of caesarean section the ERACS method is effective way to do it. ERACS is a p e r i o p e r a t i v e , i n t r a o p e r a t i v e , a n d postoperative management that aims to accelerate the patient's recovery (5).
Cesarean section is one of the main options to save the mother and fetus. The cause of delivery by cesarean section can be INTRODUCTION due to problems with the mother or baby. There are several indications for cesarean section, namely breech babies, fetal distress, surgical scars, and placenta previa (6). Many problems experienced by mothers after cesarean section is prolonged pain that affects the quality of recovery. Therefore, the ERACS method is used to reduce pain by applying various pain treatments. The dose of anesthetic drug administration is reduced so that by decreasing the dose, the recovery process is faster. A brief mobilization can speed up the recovery process (7).

Research location and time
The research was conducted at RSIA Kendangsari Surabaya. Data collection was carried out in July -August 2022.

Research Instruments and Data Collection
Methods.
To assess post-cesarean pain, the VAS ( Visual Analog Scale ), and a questionnaire was used, and the ObsQoR 11 was used to evaluate the quality of the patient's recovery.  Education, optimizing the condition of pregnant women, preparing for breastfeeding as early as possible, fasting solid food 8 hours before surgery, inserting an infusion 2 hours before surgery, given adequate intravenous fluids to avoid blood pressure drops and nausea, and vomiting.
Intraoperative Optimizing temperature, warmed IV fluids, giving <2 liters of infusion fluids, anesthetic technique by an anesthesiologist, spinal low dose bupivacaine 10 mg combined with fentanyl 2 mcg and morphine 75 mcg, spinocan size 27, administration of antibiotics to prevent infection, if possible in initiate early breastfeeding in the operating room by observing the condition of the mother and baby.
Optimizing temperature, warmed IV fluids, giving <2 liters of infusion fluids, anesthetic technique by an anesthesiologist, spinal full dose regivell 5% dose 80 mg, spinocan size 27, administration of antibiotics to prevent infection, if possible in initiate early breastfeeding in the operating room by observing the condition of the mother and baby.
Postoperative Chewing gum to stimulate intestinal peristalsis, the initial oral intake may take 60 minutes if the patient is not nauseous and continues a regular diet, early mobilization may sit 0-6 hours and continue with walking as tolerated, can walk then the catheter is removed 6 hours after surgery, given oral therapy paracetamol 1000 mg every 8 hours and 600 mg of ibuprofen each day 6 hours given after administration of ketorolac 30 mg IV.
Initial oral intake may be drunk if the legs can be moved, if the patient does not experience nausea and vomiting, continue a regular diet, postoperative analgesic petidine 200 mg, ketorolac 90 mg, ondancentron 12 mg diluted with 50 cc of aquadest in a 2.5 cc running syringe pump /hour timed out in 20 hours. Early mobilization and removal of the catheter can be carried out after the syringe pump has run out, followed by mobilization walking according to tolerance questionnaires were administered at 24 hours postoperatively, and ObsQoR-11 was administered 24 hours after surgery.     Table 4 shows that the mean quality of recovery scores in the group using the ERACS method was higher than in the group not using the ERACS method. The Independent

RESULTS
Sample T Test found that the P value < 0.000 with 95% CI - 15,193-(-18,292). This shows that the improvement in the quality of recovery scores after being given the ERACS method is not only statistically significant but also clinically significant.      (18). With the ERACS method, the patient will be able to mobilize faster so that the patient's recovery will also be faster.
The results of research conducted by Metasari and Sianipar (2018) show that early mobilization affects reducing pain. The study found that the pain level decreased with early mobilization in moderate and mild pain. Given the great responsibility of the mother for the recovery and care of the baby, early mobilization is an effort to gradually gain independence from the patient. In addition, early mobilization can train the mother's autonomy (19).
This study found that age and parity were not barriers to the ERACS method because the results showed that age and study results, the respondents' age range was 25-33 years, which is included in the fertile age range. One factor that influences pain response is age. Age is a crucial variable that affect pain. Developmental differences between the two age groups can affect how you react to pain (22).