Table 1.

Summary of the ERAS protocol used in the present study

Preoperative	Educational program	(1) Understand the patient, assess the condition
		(2) Psychological, nutrition, surgery, rehabilitation education
		(3) Good communication
		(4) Emphasize active function exercise
		(5) Advocate deep breathing, upper limbs pull rings and other cardiopulmonary exercise
	Management of nutrition	(1) If there is hypoalbuminemia and severe anemia, actively look for the original disease and correct it
		(2) When necessary, human serum albumin 10g Ivgtt
		(3) Megaloblyte anemia: folate 5-10mg Po Tid+ vitamin B12 0.5mg Im Tiw
		(4) Iron deficiency anemia: EPO 10,000 IU Ih Tiw+ Ferrous succinate 0.2g Po Tid
	Management of dietary	(1) Eat a high protein diet
		(2) Before anesthesia 6h fast protein liquid (such as milk, broth)
		(3) Before anesthesia 4h fast carbohydrates (such as rice porridge, steamed bread)
		(4) 2h before anesthesia, do not drink clear liquid
		(5) When necessary, 250-500ml glucose was dropped 2-3h before operation
	Management of sleep	(1) Sedative hypnotic or anti-anxiety drugs
	Management of pain	(1) Routine use of anti-inflammatory analgesics such as celecoxib 200mg Po Bid
Intraoperative	Selection of anesthesia	(1) General anesthesia (laryngeal mask or endotracheal intubation)
		(2) Combined with local infiltration anesthesia: ropivacaine 200 mg+80 ml saline was injected into the incision and surrounding deep needle
	Control of bleeding	(1) Blood pressure control: systolic blood pressure control in 90-110mmhg
		(2) Bleeding control: 5-10 min before skin incision, tranexamic acid should be dropped 15-20 mg/kg
	Management of body temperature	(1) Monitor and dynamically adjust the operating room temperature, do a good job of keeping warm
		(2) Reduce limb exposure, for patients covered inflatable heating blanket
		(3) The infusion of liquid will be first heated to 37°C
	Prevention of infection	(1) Ensure the operating room environment, control the number of patients involved in the operation
		(2) Strict disinfection towel, as far as possible to shorten the operation time and reduce the surgical trauma, the operation field repeatedly rinse
		(3) Preoperative 0.5-2h intravenous antibiotics
		(4) If the operation time exceeds 3h, or blood loss > 1500ml with the second dose
		(5) The effective coverage time of antibacterial drugs includes the whole surgical process and 4 hours after surgery, and the total prevention time is no more than 24h
Postoperative	Management of anesthesia	(1) General anesthesia wake up: drink water before eating
		(2) Moxapride 5mg Po Tid to improve gastrointestinal motility
		(3) Selection of anesthesia
	Management of rehydration	(1) Avoid a large amount of fluid replacement: infusion volume from 25 to 40ml (Kg/d) is appropriate
		(2) Control the infusion speed: the infusion speed of elderly patients is from 100 to 120ml/h is appropriate
		(3) Monitor blood routine, liver function, kidney function and cardiac function indicators
	Management of drainage tube	(1) No drainage or catheter was placed
	Control of nausea and vomiting	(1) Intraoperative intravenous use of dexamethasone 10 mg
		(2) Use ondansetron when necessary
	Management of sleep	(1) Sedative hypnotic or anti-anxiety drugs
	Management of pain	(1) Use of automatic analgesia pump for three days
		(2) Sequential use of anti-inflammatory and analgesic drugs, such as celecoxib 200mg Po Bid (recommended reduction of 50% for liver damage and elderly patients)
	Management of activity	(1) Emphasis on early hip, knee and ankle active flexion and extension function exercise, to increase muscle strength
		(2) Exercise passive joint flexion and extension of hip, knee and ankle joints with the help of the physician and CPM, at least 3 times a day, at least 15 minutes each time
		(3) Asked frequently turn over, clap back
		(4) Acupuncture
		(5) Manipulation