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enhanced recovery after surgery (ERAS); modified ERAS (mERAS)

Indications: - reduce postoperative complications, hospital cost, length of stay - reduce surgical stress, maintain physiological function, enhance mobilization Procedure: - procedure for minimally invasive colorectal cancer surgery - comprised preoperative, ntraoperative, & postoperative elements - patients & caregiver information with written materials & videos - patients allowed clear fluid up to 2 hours before surgery - no solid foods within 6 hours prior to induction of anesthesia - no solid foods since midnight on day of operation (modified protocol) - avoid fluid overload during & after surgery - restricting intraoperative fluid to < 2000 mL - stopping intravenous fluids on postoperative day 1 - pain control with local 0.5% bupivacaine infiltration into the wounds conclusion of surgery & oral NSAIDs as needed - perioperative epidural anesthesia not routinely used - nasogastric tube insertion avoided - patients allowed water 2 hours after surgery, 2 days of clear liquids, & 2 weeks of low-residue soft diet - mobilization encouraged within 2 hours postoperatively - bowel preparation limited to 1 day preoperatively (modified protocol) - venous thromboembolism prophylaxis with compression stockings & intermittent pneumatic compression without heparin from the operation start until out of bed - hospital discharge tolerating a soft diet, with pain well-controlled on oral analgesics

References

  1. Wei PL, Huang YJ, Wang W, Huang YM. Modified enhanced recovery after surgery protocol in octogenarians undergoing minimally invasive colorectal cancer surgery. J Am Geriatr Soc. 2024 Sep;72(9):2679-2689. PMID: 38838363 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.19026
  2. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. PMID: 28097305 Review.
  3. Ljungqvist O, Hubner M. Enhanced recovery after surgery-ERAS-principles, practice and feasibility in the elderly. Aging Clin Exp Res. 2018 Mar;30(3):249-252. PMID: 29453605 PMCID: PMC5856872 Free PMC article. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856872/