Table 1.
Components of Our ERAS Program
| ERAS Program | |
|---|---|
| Pre-operative | |
| Education | Including the purpose, workflows and benefits of ERAS program, anticipated postoperative pain and expectations and risks of surgery, through verbal and handouts |
| Nutritional counselling | Nutrition screening during the perioperative period, including nutrition screening tools and laboratory indicators. Dietitians provide personalized diet guidance and nutritional supplement to patients in need |
| Fasting | Clear fluids including carbohydrate drink allowed up to 2 hours before surgery |
| Antithrombotic prophylaxis | Active/passive limb movement and antithrombotic stockings |
| Antimicrobial prophylaxis | Antibiotic prophylaxis within 1 hour of incision |
| Intra-operative | |
| Tranexamic acid | Used routinely |
| Standard anesthetic protocol | Multimodal analgesia; TIVA-based anesthetic technique with propofol, lidocaine, ketamine, ketorolac, antiemetics and with up to 0.5% MAC inhaled anesthetics, avoid N2O; depth of anesthesia monitoring |
| Avoidance of salt and water overload | Goal-directed euvolemia |
| Maintenance of normothermia | Keeping core temperature at 36–37°C |
| Local infiltration analgesia | Used routinely |
| Post-operative | |
| Early ambulation | In-bed mobilization within 4 hours after surgery. Encourage ambulation after 4 hours, Early treatment with physical therapists |
| Early removal of bladder catheter | Remove the bladder catheter when returning to the ward |
| Early oral feeding | Oral feeding at will after recovery from anesthesia |
| Postoperative multimodal analgesia | Adequately controlled pain; visual analog scales <4: no analgesia or oral minimal dose of nonopioid; visual analog scales: 4–6: oral or intravenous nonopioid visual analog scales ≥ 7: opioid |
| Stick to Discharge Criteria | Discharge Criteria: No clinical complications; visual analog scales <3 with oral analgesics; Independent ambulation or ambulation with minimal assistance; adequate nutrition intake; absence of fever in the last 48 hours |
Abbreviations: TIVA, total intravenous anesthesia; MAC, minimum alveolar concentration.