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