W H L Teoh1, M K Shah, C L Mah. 1. Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. teohwendy@yahoo.com
Abstract
INTRODUCTION: We prospectively investigated the incidence of ileus, nausea/vomiting, and hospital course ofnon-labouring women fed immediately after Caesarean delivery under regional anaesthesia. METHODS:196 patients were randomised into either the early-fed group (250 ml clear fruit juice 30 minutes postoperatively, and unlimited solid food thereafter) or the control group (clear feeds allowed after two hours, advanced to solids as tolerated). RESULTS: Both groups had similar baseline demographics and operative characteristics. Bowel sounds were present immediately postoperatively in 90.8 percent (early group) versus 95.9 percent (control). The early-fed group had reduced time to first drink (0.86 +/- 0.6 hours versus 14.4 +/- 18.2 hours) and solid food intake (4.2 +/- 2.7 hours versus 20.0 +/- 6.8 hours), earlier passage of flatus (14.4 +/- 9.4 hours versus 21.0 +/- 10.4 hours) and first stool (44.4 +/- 18.7 hours versus 65.6 +/- 25.4 hours), shorter duration of intravenous hydration (12.8 +/- 7.5 hours versus 22.4 +/- 5.8 hours), and earlier removal of intravenous cannulae (20.5 +/- 6.7 hours versus 24.7 +/- 7.8 hours), with all p-values less than 0.001. Early-fed mothers also mobilised (23.1 +/- 6.8 hours versus 27.4 +/- 7.6 hours), commenced breastfeeding (26.5 +/- 14.1 hours versus 38.8 +/- 21.8 hours), and were ready for discharge earlier (44.3 +/- 10.4 hours versus 62.0 +/- 12.7 hours), compared to the control group, with all p-values less than 0.001. There was no difference in mild ileus symptoms (3.1 percent). Earlier solid intake resulted in more nausea (10.2 percent versus 2 percent, p-value is 0.033), which was self-limiting. Maternal satisfaction rated higher in the early-fed group (90 versus 60, on visual analogue scale score 0-100, p-value is less than 0.001). CONCLUSION: This prospective randomised trial showed no increase in ileus with early feeding post-Caesarean delivery under spinal anaesthesia, with added benefits of earlier intravenous cannulae removal, ambulation, breastfeeding initiation and potential for shorter hospitalisation. Despite increased nausea in those taking solids earlier (but not feeds), maternal satisfaction rated higher in the early-fed group.
RCT Entities:
INTRODUCTION: We prospectively investigated the incidence of ileus, nausea/vomiting, and hospital course of non-labouring women fed immediately after Caesarean delivery under regional anaesthesia. METHODS: 196 patients were randomised into either the early-fed group (250 ml clear fruit juice 30 minutes postoperatively, and unlimited solid food thereafter) or the control group (clear feeds allowed after two hours, advanced to solids as tolerated). RESULTS: Both groups had similar baseline demographics and operative characteristics. Bowel sounds were present immediately postoperatively in 90.8 percent (early group) versus 95.9 percent (control). The early-fed group had reduced time to first drink (0.86 +/- 0.6 hours versus 14.4 +/- 18.2 hours) and solid food intake (4.2 +/- 2.7 hours versus 20.0 +/- 6.8 hours), earlier passage of flatus (14.4 +/- 9.4 hours versus 21.0 +/- 10.4 hours) and first stool (44.4 +/- 18.7 hours versus 65.6 +/- 25.4 hours), shorter duration of intravenous hydration (12.8 +/- 7.5 hours versus 22.4 +/- 5.8 hours), and earlier removal of intravenous cannulae (20.5 +/- 6.7 hours versus 24.7 +/- 7.8 hours), with all p-values less than 0.001. Early-fed mothers also mobilised (23.1 +/- 6.8 hours versus 27.4 +/- 7.6 hours), commenced breastfeeding (26.5 +/- 14.1 hours versus 38.8 +/- 21.8 hours), and were ready for discharge earlier (44.3 +/- 10.4 hours versus 62.0 +/- 12.7 hours), compared to the control group, with all p-values less than 0.001. There was no difference in mild ileus symptoms (3.1 percent). Earlier solid intake resulted in more nausea (10.2 percent versus 2 percent, p-value is 0.033), which was self-limiting. Maternal satisfaction rated higher in the early-fed group (90 versus 60, on visual analogue scale score 0-100, p-value is less than 0.001). CONCLUSION: This prospective randomised trial showed no increase in ileus with early feeding post-Caesarean delivery under spinal anaesthesia, with added benefits of earlier intravenous cannulae removal, ambulation, breastfeeding initiation and potential for shorter hospitalisation. Despite increased nausea in those taking solids earlier (but not feeds), maternal satisfaction rated higher in the early-fed group.