Abstract / Summary
Introduction: Caesarean section (CS) is one of the most frequently performed major operations worldwide and is still followed by moderate-to-severe acute pain in a substantial proportion of women, compromising early mobilisation, breastfeeding and maternal–infant bonding. Enhanced Recovery After Caesarean Surgery (ERACS) is an evidence-based, multidisciplinary perioperative pathway centred on opioid-sparing multimodal analgesia; nevertheless, comparative real-world data from Indonesian private hospitals remain scarce. This study aimed to compare postoperative pain intensity after CS managed with ERACS versus conventional perioperative care. Methods: A comparative analytical cross-sectional study was conducted in the obstetrics and gynaecology inpatient ward of Hermina Arcamanik General Hospital, Bandung, Indonesia, from September to October 2025. One hundred and sixteen post-caesarean women (58 ERACS; 58 conventional) were enrolled by accidental (consecutive convenience) sampling. Pain intensity was self-rated once within 12–48 hours after surgery using the 11-point Numeric Rating Scale (NRS) and categorised as mild (1–3), moderate (4–6) or severe (7–10). The Mann–Whitney U test was applied as the primary analysis, supplemented by the effect size r and the risk ratio (RR) for moderate-to-severe pain. Results: The groups were comparable in age, parity and occupation, whereas tertiary education was more frequent in the ERACS group (43.1% vs 24.1%; p = 0.03). Mild pain predominated after ERACS (75.9% vs 29.3%), while moderate (20.7% vs 53.4%) and severe pain (3.4% vs 17.2%) were less frequent than after conventional care. ERACS was associated with significantly lower pain ranks (mean rank 44.50 vs 72.50; U = 870.0; Z = −5.005; p < 0.001; r = 0.46). Moderate-to-severe pain occurred in 24.1% versus 70.7% of women (RR 0.34; 95% CI 0.21–0.55), corresponding to a number needed to treat of approximately three. Discussion: The lower pain burden is biologically plausible in view of the synergistic, opioid-sparing analgesia, the neuraxial strategies and the early functional-recovery elements embedded in ERACS, and it accords with international meta-analyses and Indonesian single-centre studies. Non-randomised allocation, the educational imbalance between groups and a single, non-standardised assessment time point nonetheless warrant cautious interpretation. Conclusion: ERACS was associated with clinically and statistically lower pain intensity during the first 12–48 postoperative hours compared with conventional care. Standardised institutional implementation with protocol auditing is recommended, together with prospective studies incorporating repeated pain assessments, analgesic consumption and patient-reported recovery outcomes.