Case Study: ERAS Protocol for a Patient Undergoing
Cesarean Section
Patient Profile:
Name: Mrs. A.O. (Initials for privacy)
Age: 32 years
Gestational Age: 39 weeks
Gravida/Para: G2P1
Indication for C-Section: Previous C-section, maternal
request for elective repeat C-section
Comorbidities: No known medical conditions, BMI 28
kg/m²
Preoperative Phase (Before Hospital Admission)
1. Patient Education:
o The antenatal clinic nurse explain ERAS principles to
the patient and her husband, emphasizing its benefits:
faster recovery, reduced pain, and fewer
complications.
o She provided a written ERAS guide outlining dietary
recommendations, mobilization expectations, and pain
management strategies.
2. Nutritional Optimization:
o She encourage a balanced diet rich in proteins and
carbohydrates to enhance tissue healing and energy
stores.
o Carbohydrate loading: She is advised to drink a
clear carbohydrate-rich drink (e.g., malted drinks or
prescribed ERAS-specific drinks) the night before
surgery and two hours before surgery to maintain
energy levels and reduce insulin resistance.
3. Preoperative Instructions:
o Smoking cessation: Mrs. A.O. is known smoker, and
was advice on smoking cessation to avoid harming the
baby and for her health.
o Fasting guidelines: She instruct her to stop solid
foods at midnight but allow clear fluids up to two
hours before surgery to prevent dehydration.
o Bowel preparation: Routine bowel prep is avoided
unless medically indicated.
o A Day before the surgery, pre-op visit was done by
the perioperative nurse to assess patient readiness.
Consent form was signed by patient’s husband, routine
lab test were done.
Hospital Admission & Preoperative Management (Day of
Surgery)
1. Hospital Admission & Final Preparation:
o Mrs. A.O. arrives at the hospital three hours before
surgery.
o The nurse confirm that she has followed the
carbohydrate-loading instructions.
o IV fluids are started to maintain hydration without
overloading fluids.
o Antibiotic prophylaxis is administered within 60
minutes before skin incision to prevent infections.
2. Preoperative Analgesia & Anesthesia Preparation:
o Multimodal analgesia approach:
Oral acetaminophen (paracetamol) and
ibuprofen are given preoperatively to help with
postoperative pain control.
Regional anesthesia (Spinal anesthesia) is
planned instead of general anesthesia to minimize
opioid use and promote early recovery.
o No routine preoperative sedatives to avoid
drowsiness postoperatively.
Intraoperative Phase (During Surgery)
1. Anesthesia & Pain Control:
o Spinal anesthesia (bupivacaine + fentanyl) is
administered for effective pain relief while minimizing
systemic opioid use.
o No unnecessary IV opioids to reduce nausea,
vomiting, sedation and dependency postoperatively.
2. Minimizing Intraoperative Fluid Overload:
o IV fluids are administered judiciously to avoid
unnecessary swelling and delayed recovery.
3. Surgical Considerations:
o Minimally invasive surgical techniques and gentle
tissue handling to reduce stress response.
o Active warming measures to maintain normal body
temperature.
o After surgery she was transferred to the recovery
room area for monitoring and handed over to the
ward nurse.
Postoperative Phase (Recovery & Discharge Planning)
1. Early Mobilization:
o Within six hours after surgery, the ward nurse
encourage Mrs. A.O. to sit up, dangle her legs, and
attempt short walks to improve circulation and
reduce the risk of deep vein thrombosis (DVT).
o She is assisted in walking to the bathroom rather than
using a bedpan as part of early ampulation.
2. Pain Management (Opioid-Sparing Approach):
o Scheduled acetaminophen and NSAIDs are
continued postoperatively.
o If pain is severe, low-dose opioids are available as a
backup.
3. Early Feeding:
o Clear fluids are started within 2 hours after surgery.
o Regular diet is resumed within 24 hours to restore
bowel function and promote healing.
4. Prevention of Postoperative Nausea and Vomiting
(PONV):
o Ondansetron or dexamethasone is given if needed to
prevent nausea.
5. Urinary Catheter Removal:
o The urinary catheter is removed within 12–24 hours
post-surgery to facilitate early movement and reduce
infection risk.
6. Patient & Family Involvement:
o The ward nurse educate Mrs. A.O. and her family
about pain management, the importance of movement,
and signs of complications.
Discharge Criteria & Follow-Up
Mrs. A.O. meets discharge criteria within 24–48 hours
post-surgery due to ERAS implementation.
She is provided with clear discharge instructions,
including pain management at home, signs of infection, and
when to seek medical attention.
A follow-up appointment is scheduled for one week post-
op.
Outcome:
By implementing ERAS protocols, Mrs. A.O. experienced:
Shorter hospital stay (discharged in 48 hours)
Minimal opioid use with effective pain control
Early return of bowel function
No postoperative complications
Conclusion:
ERAS for cesarean section improves recovery, reduces
complications, and enhances patient experience. As a nurse, my
role in educating, supporting, and guiding patients through this
protocol is crucial for its success.
