Table 1.
Changes in perioperative care
| Traditional care | ERAS | |
|---|---|---|
| Preoperative counseling | only by surgeons | intensive (by both surgeons and anesthesiologists) |
| Preoperative fasting (oral intake) | no food on the previous day | normal diet until the previous evening |
| no drink after the previous noon | drink oral hydration solution (OS-1R) until 3 hours before surgery* | |
| Preoperative bowel preparation | usually | sometimes for colon cancer, and always for rectal cancer |
| Perioperative fluid management (avoidance of sodium/fluid overload) | no | yes (goal-directed fluid therapy) |
| Short incisions/lapascopic surgery | no | always |
| Intraoperative warm-air body heating | sometimes | always |
| Nasogastric tube | used (remove at POD1) | not used |
| Postoperative fasting | no oral intake for 3 days postoperatively | initiate oral hydration (OS-1R) on the morning of POD1* |
| start eating soup at POD5 | start eating rice at POD3 | |
| Routine postoperative mobilization care | yes (walk by POD2) | enforced (walk in the morning of POD1) |
| Non-opiate oral analgesics/NSAIDs | no | given routinely |
| Stimulation of gut motility | no | yes (use of oral magnesium oxide) |
| Early urinary catheter removal | no | yes |
| Multimodal approach | few cases | every case |
| Anesthesia and analgesics | combination of epidural analgesia and general anesthesis (use of remifentanil) | |
| Avoidance of pre-anesthetic medication (no pre-medication) | Yes | |
| Abstinence from smoking and drinking | Yes | |
*Three 500-ml plastic bottles of oral rehydration solution [OS-1R; Otsuka Pharmaceutical, Tokushima, Japan]