Table 1.

Protocol followed during the different periods

Traditional	“Enhanced recovery” protocol
Generic patient and staff education.	Patient and staff education specifically detailing “enhanced recovery” principles.
General anaesthesia, spinal, or epidural according to the preference of the anesthetist and consent of the patient.	Pre-admission medication: – Gabapentin (300 mg) on the night before surgery (to continue twice daily for 5 days). – Dexamethasone—10 mg orally on the night before surgery and 4 mg intravenously at induction.
Perioperative urinary catheterization—standard intravenous fluid until next day	Perioperative urinary catheterization—as per clinical indication.
Mobilization next day.	Low-dose spinal anesthesia: – 2–3 mL of 0.25% Bupivacaine (plain) or 2 mL of 0.5% Bupivacaine (heavy). – No intrathecal opioids.
Patient-controlled opioid analgesia intravenously	Propofol intravenous infusion (0–2.5 µg/mL) ± Ketamine (0.5 mg/kg, slow intravenous bolus).
Discharge when standardized criteria were met.	Paracetamol (1 g intravenously) ± Parecoxib (40 mg intravenously). Judicious intraoperative fluid and vasopressor administration. Tranexamic acid (15 mg/kg—slow intravenous bolus at induction; withheld in cases of thromboembolic event in the last 6 months). Intra- and postoperative infiltration of local anesthetic (100 mL levobupivacaine 1.25 mg/mL). Aim for same-day mobilization. Discharge when standardized criteria met.