Multimodal analgesia: Optimal pain management while avoiding opioids is a key enabler of patient recovery. Furthermore, poor acute pain management is a strong risk factor for the development of chronic pain. A multimodal approach is recommended, using multiple strategies before, during and after surgery. Intraoperatively: For open surgery, neuraxial blockade via thoracic epidural combining local […]
As part of a complete ERP approach, with immediate oral intake, PONV prophylaxis, ileus prevention and multimodal analgesia, the “maintenance” IV infusions are stopped within 24 hours of surgery and the IV line heparin-locked to encourage mobilization and functional independence. For more information, see Chapter 11: Fluid Management in The SAGES / ERAS® Society Manual […]
There is a narrow range for optimal fluid therapy with a goal of maintaining euvolemia and avoiding both underhydration and salt and water excess. The complication rate goes up with fluid overload of as little as 3L in elective bowel surgery, especially with crystalloids (1). Use of a balanced crystalloid solution (eg Ringer’s lactate) is […]
Staying in bed leads to deconditioning that can largely be prevented by physical activity (1). In the context of ERPs, being out of bed on POD0 and POD1 are independent predictors of shorter hospital stay (2). There is little available evidence to suggest what amount of mobilization improves outcomes. Patients are helped to be out […]
Mild hypothermia through shivering and vasoconstriction elicits a stress response and increases rates of surgical site infection. Passive and active warmers are used to maintain normothermia (>35.5°). (1) For more information, see Chapter 7: Prevention of Hypothermia in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery References 1. Forbes SS, […]