Table 1 The ERAS program adopted in this trial.

From: Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

Preoperative procedures

Preoperative assessment, education and psychological counseling by talk, text and caption

Preparation before admission: cessation of smoking and alcohol for 14 days, quick walk for 30 min daily, oral enteral nutritional powder if plasma albumin ≤ 30 g/L, infuse red blood cell if Hb < 70 g/L

No preoperative use of sedatives or anticholinergic drugs

No bowel preparation, fasting for 6 h, and oral 10% glucose 500 ml 2 h before surgery

No routine placement of gastric tube; if necessary, remove it as soon as possible

Antibiotic prophylaxis 30 min before surgery

Use heparin to prevent deep vein thrombosis for high risk patients and monitor coagulation

Intraoperative procedures

Continuously monitor body temperature and maintain its stability by warmed blanket, warmed infusion and preheated peritoneal irrigation

Infuse crystal liquid mainly and restrict the volume (CVP ≤ 10 mmHg); rapidly infuse 200–300 ml colloidal fluid if severe hypotension occurs during the implementation of controlled-low CVP

No routine placement of peritoneal drainage tube; if necessary, remove it within 48 h

Anesthesia method: ETI general anesthesia for the control group, LMA general anesthesia combined with a subcostal TAP block for the TAP + LMA group

Use of short-acting anesthetics (i.e. remifentanil, sufentanil, propofol and sevoflurane)

Monitor anesthetic depth and maintain its stability

Intravenous tropisetron 10 mg for preventing postoperative nausea and vomiting

Postoperative procedures

Multimodal postoperative analgesia: a. a single-shot regional block (local wound infiltration for the control group and a subcostal TAP block for the TAP + LMA group); b. patient-controlled intravenous analgesia (PCIA) with sufentanil; c. intravenous parecoxib 40 mg twice daily for 3 days; d. oral analgesic

Assess pain intensity with numerical rating scale (NRS) and inject additional analgesic when NRS score ≥ 5

Intravenouslydrip dexamethasone 5 mg daily for 3 days to alleviate inflammation

Treatment of postoperative nausea and vomiting

Remove drainage tube and urinary tube as soon as possible

Early oral intake: a little water on the day of surgery; liquid diet on 1st postoperative day; semi-liquid

diet on 2nd postoperative day; normal diet from 3rd postoperative day on

Early mobilization: exercise in bed on the day of surgery; walk in the ward at least twice on 1st postoperative day; walk at least 4 times on 2nd postoperative day; continuously walk from 3rd postoperative day on

Use low molecular weight heparin to prevent deep vein thrombosis

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