Table 1.
Components of an ERAS protocol.
| ERAS category | Component |
|---|---|
| Preoperative | Preadmission education about ERAS |
| No smoking, no alcohol, respiratory function training if necessary | |
| Carbohydrate drink until 10 and 2 h before surgery | |
| No bowel preparation | |
| No diazepam sedatives | |
| Antibiotic prophylaxis half an hour before the operation | |
| Intraoperative | Optimize the anesthetic program (general anesthesia combined with epidural anesthesia) |
| Minimally invasive incisions (preference for laparoscopic or robotic surgery) | |
| Active warming (aim for body temperature of 37 °C) | |
| Preventive analgesia (TAP, PCA, and subcutaneous injection of ropivacaine) | |
| Avoidance of nasogastric tubes and drains (if used, early removal) | |
| Liquid management (choosing vasoconstrictor drugs to control blood pressure) | |
| Postoperative | Postoperative antiemetic (tropisetron hydrochloride, IV BID) |
| Pain management (continue to place PCA, flurbiprofen axetil injection IV BID), VAS is performed daily | |
| Urinary catheter removed on first postoperative day, early nasogastric tube and drain removal | |
| Oral diet initiated from saline to liquid diet to semi-liquid diet, use pharmacological nutrients if necessary | |
| First postoperative day: 15–30 ml of normal saline was administered; thereafter, a liquid meal (rice soup, short peptides, total nutrients, glutamine, water-soluble vitamins, salt) of 15–30 ml was provided. In the second meal, after gastrointestinal tolerance, a liquid meal of 50–80 ml was dispensed | |
| Second postoperative day: a liquid meal of 80–100 ml was dispensed (rice soup, short peptides, total nutrients, glutamine, multivitamins, trace elements, salt); if no adverse reactions, adjustment continued gradually to 100–150 ml, q4h | |
| Third postoperative day: liquid diet + semi-liquid diet | |
| Fourth postoperative day: liquid diet + semi-liquid diet, gradually increasing the proportion of the semi-liquid diet | |
| Fifth postoperative day: gradually transition to a semi-liquid diet | |
| Monitoring of blood glucose, TID | |
| Promote the recovery of intestinal function (lactulose oral solution 15 ml, two or three times a day) | |
| Early ambulation (active mobilization in bed at least 6 h on first postoperative day, ambulation out of bed at least 2 h on second postoperative day) | |
| Defined discharge criteria | |
| Quality of life evaluation by the QoR-40 scale | |
| Discharge criteria | For the recovery of bowel function, there is no need for intravenous fluids. Oral feeding can reach the preoperative intake level of 70% |
| No analgesia was required, or the patient’s pain control was tolerable without intravenous analgesia or oral analgesics alone (VAS pain score ≤4) | |
| Able to complete daily activities and take care of themselves | |
| Pulse, blood pressure, heart rate, and body temperature should remain stable and at the same level as before surgery. Biochemical parameters, such as white blood cell count and hemoglobin, should be stable and maintained within a reasonable range | |
| Patients are willing to leave the hospital |
ERAS, enhanced recovery after surgery; IV, intravenous; VAS, visual analogue scale; PCA, patient controlled analgesia; TAP, transversus abdominis plane block; QoR-40, quality of recovery-40 questionnaire.