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Master Thesis

« Pertinence » de l’application standardisée d’un protocole de réhabilitation précoce post-césarienne : analyse et amélioration des pratiques professionnelles

Abstract : Objectives : In 2014, three maternities units in Reunion Island adopted an Enhanced Recovery Programme (ERP) following cesarean section. The programme was based on the use of carbetocin (Pabal®) as the uterotonic agent, combined with multimodal analgesia, side effects prevention, removal of catheters before leaving the recovery room, early mobilization and early return to oral intake. The aim was to determine the "appropriateness" (safety, efficiency, and cost) of this protocol compared to the conventional protocol (with Syntocinon®). Methods : Comparative, prospective and multicenter study, of patients who underwent a cesarean section at 37 weeks of gestation and beyond, who either received the ERP or the standard protocol. The efficacy endpoint was maternal satisfaction with the management of pain and the maternal-newborn bond, by calculating an overall satisfaction score. Results : 272 patients underwent ERP (ERP group) and 95, the conventional care (NO ERP group). For patients with previous cesareans, 75.2% of ERP group considered this new protocol to be better, compared to 46.4% (p=0.01) of NO ERP group. The satisfaction score was also significatively higher in this group (p=0.03). The rate of early and late complications was low, with no difference between the two protocols. The cost of analgesic consumption per patient was reduced to 30% for ERP group (€6.74 vs €9.76, p<0.0001), and the initial additional costs generated by the systematic use of Pabal® (€26 vs. €1.86) did not cause additional costs in the 2014 average drugs cost of the maternity ward. Conclusion : ERP following cesarean section seems therefore more relevant than the conventional protocol, with an improvement in the management of pain, the patient satisfaction (effectiveness) with no increase in complications (safety), end the systematic use of Pabal® does not cause additional costs in the maternity ward.
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Master Thesis
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Submitted on : Wednesday, January 6, 2016 - 10:00:07 AM
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Jessica Dospeux. « Pertinence » de l’application standardisée d’un protocole de réhabilitation précoce post-césarienne : analyse et amélioration des pratiques professionnelles. Médecine humaine et pathologie. 2015. ⟨dumas-01244715⟩

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