Mesut ADMIŞ, Özlem ADMIŞ, Emine YILMAZ GÜLER, İlke DOLGUN, Ali ÇETİN, Numan ÇIM, Paşa ULUĞ
Medical Science and Discovery - 2026;13(7):150-159
Objective: Postoperative nausea and vomiting (PONV) remain a common and distressing complication following cesarean delivery, often delaying oral intake, mobilization, and maternal-infant bonding. Although Enhanced Recovery After Surgery (ERAS) pathways incorporate multimodal strategies to mitigate PONV, randomized obstetric data evaluated via validated PONV scoring instruments remain limited. Methods: In this single-center, prospective, randomized controlled trial, 126 women undergoing elective cesarean delivery under spinal anesthesia were assigned to either an ERAS pathway or conventional care (n = 63 per group). The study evaluated two institutional perioperative care pathways approved by the local ethics committee without introducing experimental drugs, devices, or off-protocol interventions. The primary outcome was 24-hour PONV incidence. Secondary outcomes included PONV severity (assessed by the Rhodes PONV Index and a visual analog scale [VAS]), rescue antiemetic requirements, total opioid consumption, time to first oral intake, length of hospital stay, postoperative complications, and patient satisfaction. Results: PONV occurred in 11/63 patients (17.5%) in the ERAS group compared to 25/63 patients (39.7%) in the control group (risk ratio, 0.44; 95% CI, 0.24 to 0.82; p = 0.010). Mean total Rhodes scores were significantly lower in the ERAS group (1.38 +/- 3.39 vs. 4.43 +/- 6.45; mean difference, -3.05; 95% CI, -4.85 to -1.25), with lower VAS nausea scores observed at 0-6, 6-12, and 12-24 h intervals. Rescue antiemetics were administered to 0/63 ERAS patients versus 20/63 controls (31.7%). Patients in the ERAS arm achieved earlier oral intake, required lower total perioperative opioids, had shorter hospital stays, and reported higher satisfaction scores. Postoperative complication rates were comparable between groups (9.5% vs. 11.1%, p > 0.05). Conclusions: In this trial, implementing a bundled ERAS pathway incorporating routine antiemetic prophylaxis significantly reduced the incidence and severity of PONV, decreased opioid consumption, accelerated recovery milestones, and improved overall patient satisfaction. Given the bundled nature of the intervention, these findings reflect the combined effect of the pathway and should be generalized accordingly.
