If patient wishes to try TOLAC prior to having/needing C-section, they CANNOT be considered an ERAS patient. Please do not schedule them as ERAS or tag them as "Yes, ERAS pt" in Dimensions.

PRIOR TO SCHEDULED C-SECTION DATE

• ERAS education begins in surgeon’s office

• ERAS education class and Clearfast

  • • Distribution provided in mandatory C-section ERAS following 36 week prenatal appointment

    • Notify Corporate Ed so patient can be scheduled for education class

    • Give patient Clearfast with instructions

      • • 1 Clearfast drink the night before surgery

        • Morning of surgery: 1 Clearfast drink prior to coming to hospital (3 hours before scheduled C-section time)

• Distribution of Patient Guide to ERAS

PRE-OP

• Multimodal Analgesia

  • • Acetaminophen 1 g PO

    • Bicitra 30 mL PO

    • Pepcid 20 mg IV

    • IV insertion, hep-locked

    • LR Bolus 750 mL WARMED FLUIDS once notified OR available

INTRA-OP

• Ketorolac 15 mg IV

  • • Multimodal analgesia

    • Given at end of case if appropriate for individual patient

    • CRNA to confirm with surgeon first before administering

PACU

• DIET

  • • Eat and Drink in PACU ASAP as wanted by patient

• Initiate abdominal binder

  • • Continue to postpartum unit

• Transfer to Postpartum

  • • After sufficient regression of neuraxial blockade, patient and baby transferred to postpartum unit

POSTPARTUM UNIT

• Diet

  • • Continue regular diet immediately

• Abdominal Binder

  • • Continue from PACU

• MULTIMODAL-non-opioid analgesics as first line

  • • Acetaminophen 1 g PO Q8 hrs (Not ordered as "while awake")

    • Ketorolac 15 mg IV Q6 hrs (POD 0 only, then change to ibuprofen)

    • Ibuprofen 600-800mg PO Q6- BEGIN POD 1 after Ketorolac d/c

    • Oxycodone 5-10 mg PO Q4hrs PRN

    • IV opioids for severe breakthrough pain

• AMBULATION

  • • POD #0- x1

    • POD #1- x3

    • POD #2- x4-6

• Foley Catheter

  • • Removal 6hrs after insertion (when patient can safely ambulate to bathroom

• No Ambien

• RhoGAM

  • • POD #2 if necessary

• Discharge prescription

  • • multimodal analgesia regimen to be continued and minimal opioids for breakthrough pain.

• Defined discharge criteria

  • • Discharge anticipated for POD #2

    • Ambulate independently (with abdominal binder on)

    • Tolerating diet

    • Pain controlled with oral pain medication

    • Afebrile

    • Able to urinate