Table 1.
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. |