Table 1 The perioperative ERAS protocol.
Measure | Details |
|---|---|
Preoperative | |
Prehibilitation | Yes |
Information and counseling about the surgery | Information about ERAS protocols and MDT |
Bowel preparation | No |
Preoperative fasting | Normal meal until 6 h before surgery |
Carbohydrate loading | 500 ml of 10% carbohydrate 2 h before surgery |
Nasogastric tube | No nasogastric tube before surgery |
Checklist and Timeout | Yes |
Intraoperative | |
Minimally invasive surgery (Lap./Rob.) | Yes |
Incision size | Small incision in premise of fully exposed to the surgical field |
Anesthesia | A combination of epidural analgesia (Th7-8) and general anesthesia |
Intraoperative warming | Thermal insulation blanket during the surgery, Rinsing intraperitoneally with warm saline after surgery |
Antibiotic use | Using once 30 min before surgery, the additional one if surgery lasts more than 3 h |
Postoperatve | |
Abdominal drainage | Removed 24 h after surgery |
Incision suture | Absorbable suture without stitches |
Analgesia postoperatively | Subcutaneous injection of long-acting local anesthetic drug in the incision, epidural analgesia postoperatively, i.v. nonsteroidal anti-inflammatory drugs (NSAIDs) |
Urinary catheter | Removed 24 h after surgery |
I.v. infusion of liquid | About 2000 ml per day |
Mobilization | Encourage patients to mobilize in bed the day of surgery, mobilize out of bed the first day after surgery |
DVT prevention programs | Antithrombotic stockings, Application of Antithrombotic pump during the intraoperative and postoperative, Prophylactic heparin, early ambulation |
Diet reintroduction | Oral intake of a little clear water as soon as effects of anesthesia disappeared, following a stepwise plan from oral liquid food to normal diet, supplemented with parenteral nutritional |
