Post-Cesarean Gastrointestinal Dysfunction

Elazıg Fethi Sekin Sehir Hastanesi102 enrolled

Overview

General anesthesia has a range of effects that can lead to gastrointestinal (GI) system dysfunctions in the postoperative period. These effects are linked to various factors, from the pharmacological properties of anesthetic agents to neurohumoral effects triggered by surgical stress. Commonly encountered GI dysfunctions include nausea and vomiting, abdominal distension due to decreased intestinal peristalsis and the postoperative inflammatory response, delayed gastric emptying, ileus, fatigue, and delayed initiation of oral feeding. These conditions can prolong hospital stay, increase treatment costs, and reduce patient comfort. In clinical practice, protecting GI function and preventing complications after general anesthesia are of great importance. One of the main goals of applying Enhanced Recovery After Surgery (ERAS) protocols is to reduce the surgical stress response, thereby promoting rapid recovery and improving GI functions. Postoperative gastrointestinal (GI) dysfunction after cesarean section is a common complication that negatively impacts the recovery process. This condition manifests with symptoms such as abdominal pain, nausea, vomiting, and an inability to pass flatus, and it can prolong hospital stay and increase costs. Opioid analgesics are known to negatively affect postoperative GI motility, and regional anesthesia techniques can alleviate these problems by reducing opioid requirements. Fascial plane blocks like the TAP block are thought to reduce somatic and visceral pain by injecting local anesthetics between the deep and superficial layers of the fascia, and may positively influence GI functions through sympathetic blockade. This study aims to observationally investigate the effect of ultrasound-guided transabdominal plane (TAP) block on postoperative gastrointestinal system (GI) dysfunctions in patients who have undergone cesarean section.

Postoperative Gastrointestinal Dysfunction (POGD) refers to a collection of clinical symptoms that arise after general anesthesia, encompassing disruptions in normal gastrointestinal (GI) peristaltic activity and imbalances in absorption and secretion. This condition develops as a result of a complex interaction of neurological, inflammatory, pharmacological, and metabolic factors. These symptoms include nausea and vomiting, gastroparesis, delayed flatus and defecation, delayed oral feeding, abdominal distension, and pathophysiological changes like paralytic ileus. Many risk factors affect POGD after Cesarean Delivery (CD) surgery. Predisposing factors include the surgical method, degree of abdominal adhesions, amount of opioid use, postoperative blood transfusion, bowel manipulation, duration of surgery, advanced age, and infection and inflammation statuses. In patients undergoing CD under general anesthesia, POGD disorders are observed due to surgical stress and opioid use. The Enhanced Recovery After Cesarean Delivery (ERAC) protocol offers a multidisciplinary, holistic approach that reduces POGD and accelerates maternal recovery through a set of perioperative care guidelines. The Transabdominal Plane (TAP) block, a regional anesthesia technique with proven efficacy in postoperative pain management after CD, holds an important place within the modern multimodal analgesia approach of ERAC protocols. By reducing opioid consumption, it decreases the prevalence of POGD and enhances maternal comfort, indirectly contributing to newborn care. To reflect patients' subjective experiences regarding postoperative GI symptoms, the PRO-diGI (Patient-Reported Outcome Measure for Gastrointestinal Dysfunction after major abdominal surgery) scale has been developed and is being effectively used. The Obstetric Quality-of-Recovery score (ObsQoR-11) is a Patient-Reported Outcome Measure (PROM) developed to comprehensively and standardly assess the quality of maternal recovery after childbirth. This score, whose reliability and validity have been proven in the Turkish population (ObsQoR-11T), clinically and objectively evaluates the postpartum period by considering both physical symptoms and the mother's psychological well-being and functional capacity. This study aims to determine the effects of ultrasound-guided TAP block on recovery quality assessment (ObsQoR-11T score), postoperative gastrointestinal dysfunction (PRO-diGI score), and gastrointestinal motility (Perlas Score determined by USG) in patients who have undergone CD.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients undergoing elective cesarean section surgery under general anesthesia Patients with American Society of Anesthesiologists (ASA) physical status I-II-III Patients able to understand and respond to the Visual Analog Scale (VAS) for pain No history of drug or alcohol addiction No coagulation disorders No anatomical abnormalities of the gastrointestinal system No gastrointestinal motility disorders No previous abdominal surgery No allergies to local anesthetic drugs No history of diabetes mellitus No severe systemic diseases No intraoperative surgical complications (such as bleeding, conversion to open surgery, or organ injury) Successful block achievement (for relevant groups) Exclusion Criteria: * Patients undergoing emergency cesarean section under general anesthesia Patients with American Society of Anesthesiologists (ASA) physical status IV-V Patients unable to understand the Visual Analog Scale (VAS) for pain (due to cognitive or psychiatric disorders, or mental impairments) Emergency operations Patients with drug or alcohol addiction Coagulation disorders Anatomical abnormalities of the gastrointestinal system Gastrointestinal motility disorders Previous abdominal surgery Allergy to local anesthetic drugs Diabetes mellitus Presence of severe systemic disease Intraoperative surgical complications (such as bleeding, conversion to open surgery, organ injury, etc.) Unsuccessful block placement

Outcomes

Primary Outcomes

PRO-diGI (Patient-Reported Outcome Measure for Gastrointestinal Dysfunction after major abdominal surgery)

Patients will be asked 15 questions from the PRO-diGI (Patient-Reported Outcome Measure for Gastrointestinal Dysfunction after major abdominal surgery) scale to assess GI dysfunction.The first response option was given the highest score of 4 points, and the last response option was given the lowest score of 0 points. Patients received a maximum score of 60 points when their GI function was in the best condition.

Time frame: 24. hour, 48. hour, 72. hour

Secondary Outcomes

The Obstetric Quality-of-Recovery score (ObsQoR-11)

The Obstetric Quality-of-Recovery score (ObsQoR-11) is a Patient-Reported Outcome Measure (PROM) developed to provide a standardized and comprehensive assessment of maternal postpartum recovery quality.The ObsQoR-11 score is a scale used to assess the quality of recovery in mothers after a cesarean section, ranging from 0 (indicating the worst recovery) to 110 (indicating the best recovery); higher scores signify a better quality of recovery in terms of the mother's physical symptoms, psychological well-being, and functional capacity.

Time frame: 24. hour