Originally introduced for colorectal surgery and subsequently expanded to include other surgical specialties, Enhanced Recovery After Surgery (ERAS) protocols aim to reduce hospital length of stay, cost, and complication rates while increasing patient comfort and satisfaction. Protocols include multimodal strategies designed to attenuate the surgical stress response and preserve organ function during the perioperative period, key elements of which include preoperative counselling, nutrition optimization, standardized anesthetic and analgesic regimens, and early mobilization.
Basic components of an ERAS protocol:
Preoperative Period:
- Patient education
- Physical conditioning
- Optimize nutrition, carbohydrate loading, and hydration immediately prior to surgery
- Multimodal analgesia (non-opioid PO analgesics such as acetaminophen, gabapentin, and celecoxib)
- Glycemic control (may postpone surgery if HgbA1c is elevated)
Intraoperative Period:
- Multimodal analgesia, minimize narcotics
- Utilization of neuraxial techniques when appropriate
- PONV prophylaxis
- Goal-directed fluid therapy
- Maintenance of normoglycemia, normothermia
- Minimally invasive surgical techniques
Postoperative Period:
- Early enteral nutrition when appropriate
- Continued PONV prophylaxis
- Early ambulation
- Multimodal analgesia
- Minimize IV fluids
- Restore bowel motility (μ-opioid antagonists, chewing gum)
- Early removal of tubes and drains
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