Regarding ERAS (Enhanced Recovery After Surgery) protocols for elective cesarean section, which intervention has the strongest evidence for reducing time to return of bowel function and length of hospital stay?

• A Routine nasogastric tube placement with early removal at 24 hours
• B Early oral intake within 2 hours postoperatively and early ambulation within 8 hours ✓
• C Routine alvimopan (μ-opioid receptor antagonist) for all cesarean sections to reduce ileus
• D Mandatory carboprost IM postoperatively to reduce uterine blood loss as part of ERAS

Explanation

ERAS protocols for cesarean section (ERAS Society guidelines 2019) emphasize early oral feeding (within 2 hours of uncomplicated cesarean) and early mobilization (within 6-8 hours) as core elements with strong evidence for reducing paralytic ileus, shortening hospital stay, and improving patient satisfaction. Other ERAS elements include: carbohydrate loading preoperatively, avoiding prolonged fasting, standardized analgesia (spinal morphine + NSAIDs + paracetamol with minimal opioids), early catheter removal (<12 hours), and limiting IV fluids. Nasogastric tubes are not routinely used. Alvimopan has limited evidence for cesarean section. Active management of the third stage with oxytocin (not carboprost) is standard.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.