Early compared with delayed oral fluids and food after caesarean section

 

Abstract

Background

It is customary for fluids and/or food to be withheld for a period of time after abdominal operations. After caesarean section, practices vary considerably. These discrepancies raise concern as to the bases of different practices.

Objectives

To assess the effect of early versus delayed introduction of fluids and/or food after caesarean section.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001).

Selection criteria

Clinical trials with random allocation comparing early versus delayed oral fluids and/or food after caesarean section were considered. The participants were women within the first 24 hours after caesarean section. The criteria for 'early' feeding were as defined by the individual trial authors - usually within six to eight hours of surgery.

Data collection and analysis

Trials considered were evaluated for methodological quality and appropriateness for inclusion. For dichotomous data, relative risks and 95% confidence intervals were calculated. Continuous data were compared using weighted mean difference and 95% confidence interval. Sub-group analyses were performed for general anaesthesia, regional analgesia and where anaesthesia was mixed or undefined.

Main results

Of 12 studies considered, six were included in this review. Four were excluded and two are pending further information. The methodological quality of the studies was variable. Only one to three studies contributed usable data to each outcome. Three studies were limited to surgery under regional analgesia, while three included both regional analgesia and general anaesthesia.

Early oral fluids or food were associated with: reduced time to first food intake (one study, 118 women; the intervention was a slush diet and food was introduced according to clinical parameters; weighted mean difference -7.20 hours, 95% confidence interval -13.26 to -1.14); reduced time to return of bowel sounds (one study, 118 women; -4.30 hours, -6.78 to -1.82); reduced postoperative hospital stay following surgery under regional analgesia (two studies, 220 women; -0.75 days, -1.37 to -0.12 - random effects model); and a trend to reduced abdominal distension (three studies, 369 women; relative risk 0.78, 95% confidence interval 0.55 to 1.11). No significant differences were identified with respect to nausea, vomiting, time to bowel action/ passing flatus, paralytic ileus and number of analgesic doses.

Authors' conclusions

There was no evidence from the limited randomised trials reviewed, to justify a policy of withholding oral fluids after uncomplicatedcaesarean section. Further research is justified.

 

Plain language summary

Early compared with delayed oral fluids and food after caesarean section

Drinking and eating again soon after caesarean section does not seem to cause women any problems, and may even speed recovery.

There is a lot of variation in policies about when women are allowed to eat or drink after caesarean section. In some hospitals, women are not allowed to have food or fluids for more than 24 hours after the operation, in the belief that it might take a while for the bowels to settle down after abdominal surgery. However, caesarean section may not disrupt bowel function at all. The review found the evidence from trials does not justify withholding food and drink after uncomplicated caesarean section. There is some evidence, although not strong, that early food and drink might speed bowel recovery.

 

摘要

背景

剖腹產後提早和延遲經口進食液體和食物的比較

習慣上會在腹部手術之後暫停進食液體和/或食物一段時間，剖腹產後，實務上有相當多變異，這些差異因為不同實務根據考量而增加

目標

評估剖腹產後提早和延遲經口進食液體和食物的效果

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group trials register (2002年1月)以及Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001)

選擇標準

隨機分派之臨床試驗，比較剖腹產後提早和延遲經口進食液體和/或食物。研究對象是剖腹產後24小時內的婦女。提早進食的定義根據個別試驗作者而有不同，通常在術後6 – 8小時內

資料收集與分析

納入之試驗需考量方法學品質與適用性。對於二分法之資料，計算相對風險和95% 信心區間，使用加權平均差異和95% 信心區間代表連續型資料。對全身麻醉、區域止痛和混合型麻醉或未定義者進行次組分析

主要結論

考量的12篇研究中，排除4篇，2篇須等後續資訊，納入其他6篇進行回顧。研究方法品質各異，只有1 – 3篇研究對每項結果有可用資料。3篇研究侷限在區域止痛之手術，3篇包括區域止痛和全身麻醉。提早口服液體或食物與以下有關：減少第1次進食的時間(1篇研究、118名婦女；根據臨床參數導入食物泥等介入方式；weighted mean difference為 −7.20小時，95% CI為 −13.26至 −1.14)；減少恢復腸蠕動音的時間(1篇研究、118名婦女； −4.30小時， −6.78至 −1.82)；區域止痛手術後的住院天數減少(2篇研究、220名婦女； −0.75天， −1.37至 −0.12、隨機效果模式)；腹脹傾向減少(3篇研究、369名婦女；RR為0.78, 95% CI為0.55 – 1.11)。噁心、嘔吐、腸道運動/放屁時間、麻痺性腸阻塞和麻醉劑量次數等方面沒有顯著差異

作者結論

回顧的有限隨機試驗，沒有證據可釐清無併發症剖腹產之後暫停口服液體的政策，需要後續研究

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

剖腹產後提早和延遲經口進食液體和食物的比較。 剖腹產之後立即再度飲食似乎不會引起任何問題，或許還可以加速恢復。有關婦女剖腹產之後允許飲食的政策差異很大。在某些醫院，婦女在術後24時以上還不允許飲食或液體，認為需要一點時間讓腸道在腹部手術之後恢復適應，不過，剖腹產對於腸道功能一點也不會影響。回顧發現，這些試驗的證據，無法證明無併發症之剖腹產後暫停飲食。有一些較不強烈的證據認為，提早飲食可以加速腸道功能恢復