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This prospective randomized controlled clinical trial aims to evaluate the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols in patients undergoing elective hysterectomy. ERAS is an evidence-based perioperative approach designed to reduce surgical stress, accelerate recovery, and improve clinical outcomes. Participants will be randomized to receive either ERAS-based care or conventional perioperative management. The study will assess whether ERAS implementation reduces hospital stay and improves postoperative recovery without increasing complications.
Enhanced Recovery After Surgery (ERAS) protocols are structured, multidisciplinary perioperative care pathways developed to optimize surgical outcomes by minimizing physiological stress and promoting early recovery. These protocols include preoperative counseling, shortened fasting with carbohydrate loading, opioid-sparing anesthesia, early feeding, and early mobilization.
Hysterectomy remains one of the most common gynecological procedures worldwide and is often associated with prolonged hospital stay and postoperative morbidity, particularly in resource-limited settings. While international evidence supports the benefits of ERAS in improving outcomes such as reduced length of hospital stay, improved pain control, and decreased complications, there is a need for locally generated data to validate its effectiveness in Egyptian tertiary healthcare settings.
This study will be conducted at Kasr Al-Ainy Hospital, Cairo University, and will include women undergoing elective hysterectomy for benign or early-stage malignant gynecological conditions. Participants will be randomly assigned to either the ERAS group or the conventional care group. Outcomes will be assessed during hospitalization and up to 30 days postoperatively.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ERAS group | Active Comparator | Preoperative counseling Reduced fasting and carbohydrate loading Standardized anesthesia with reduced opioid use Early oral feeding Early mobilization Multimodal analgesia IV dextrose infusion (5%) 500 ml once or apple juice( 200-400 mL) 2-3 hours before anesthesia |
|
| Conventional care | No Intervention | Overnight fasting Delayed postoperative feeding Opioid-based analgesia Delayed mobilization Routine prolonged use of drains/catheters |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| dextrose (5%) | Drug | IV dextrose infusion (5%) 500 ml once ,2-3 hours before anesthesia |
| |
| Measure | Description | Time Frame |
|---|---|---|
| length of hospital stay (LOS) | Time from completion of surgery to hospital discharge readiness, measured in days. | From day of surgery up to 7 postoperative days |
| Measure | Description | Time Frame |
|---|---|---|
| postoperative pain score | Postoperative pain intensity measured using the Visual Analog Scale (VAS), a 10-cm scale ranging from 0 (no pain) to 10 (worst imaginable pain). | At 12 and 24 hours postoperatively |
| time to first bowel movement |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ehab H Sorour, MD | Contact | +201112496821 | dr.ehabsorour@gmail.com | |
| Mohamed E El Mahy, MD | Contact | +201111831716 | mohammed.elmahy@kasralainy.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| Ehab H Sorour, MD | Cairo University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| faculty of medicine-Cairo university | Cairo | Egypt |
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| ID | Term |
|---|---|
| D005947 | Glucose |
| ID | Term |
|---|---|
| D006601 | Hexoses |
| D009005 | Monosaccharides |
| D000073893 | Sugars |
| D002241 | Carbohydrates |
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| ERAS protocols |
| Procedure |
Reduced fasting Early oral feeding Early mobilization |
|
the interval (in hours) from completion of surgery to the first documented passage of stool."
| Up to 5 postoperative days |