Enhanced Recovery After Surgery

Abstract

Perioperative surgical care is undergoing a paradigm shift. Traditional practices such as prolonged preoperative fasting (nil by mouth from midnight), bowel cleaning, and reintroduction of oral nutrition 3-5 days after surgery are being shunned. These and other similar changes have been formulated into a protocol called Enhanced Recovery After Surgery (ERAS) pathway. It is a multimodal perioperative care pathway designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of an ERAS protocol include preoperative counseling, optimization of nutrition, standardized analgesic and anesthetic regimes, and early mobilization. The recent literature is heavily influenced by colorectal surgery, but the principles are now being applied to a wide range of disciplines. As they challenge traditional surgical doctrine, the implementation of ERAS guidelines has been slow, despite the significant body of evidence indicating that ERAS guidelines may lead to improved outcomes.

Patients’ self‐reported nausea: Validation of the Numerical Rating Scale and of a daily summary of repeated Numerical Rating Scale scores

“…This behaviour may also apply for nausea. In postoperative recovery, the importance of retaining an appetite (Allvin, Berg, Idvall, & Nilsson, 2007;Steenhagen, 2016) means that any nausea, regardless of score, affecting food intake should be avoided as far as possible. Therefore, the use of fixed cut points when offering treatment for nausea is considered doubtful.…”

“…Postoperative nausea and vomiting (PONV) after surgery affects many patients (Allvin, Ehnfors, Rawal, & Idvall, 2008;Macario, Weinger, Carney, & Kim, 1999). Urgent prevention and treatment of PONV are therefore indicated to minimise patient discomfort, the risk of medical complications (Apfel et al, 2012;Steenhagen, 2016) and the costs involved due to prolonged hospital stays (Bamgbade, Oluwole, & Khaw, 2017). When unrecognised by health care professionals, patients' experience of PONV is an important source of dissatisfaction with care (Bamgbade et al, 2017;Roh et al, 2014) and, together with pain, is considered a major barrier to recovery (Allvin et al, 2008;Bamgbade et al, 2017).…”

ERAS: History and philosopy

“…ERAS protokolleri geleneksel, hatta dogmatik bile denilebilecek cerrahi ve anestezi uygulamalarının dışına taşmakta ve radikal olarak nitelendirebilecek yenilikler getirmektedir. Protokol, perioperatif dönemde uygulanacak 20'den fazla kanıta dayalı elemanı içermektedir (4,5,7,8) (4) . Her bir ögenin diğerine sinerjik bir etkisi olmaktadır.…”

GLP1 Receptor Agonist Liraglutide Is an Effective Therapeutic Option for Perioperative Glycemic Control in Type 2 Diabetes within Enhanced Recovery After Surgery (ERAS) Protocols

“…Perioperative ERAS protocols, which have been reported since the late 1990s [1, 2], form an evidence-based integrative multimodal rehabilitation program that enhances safety and promotes quick postoperative recovery by maintaining preoperative organ function and reducing profound stress responses following surgery [3-5]. Perioperative nutritional management is a key element of ERAS protocols [6].…”