Enhanced Recovery after Surgery

Abstract

Enhanced recovery after surgery (ERAS) protocols are specialized perioperative care guidelines. The protocol was first published in 2005. Since then, it has been associated with improved perioperative outcomes. This multimodal peri-operative protocols standardize the perioperative care to minimize the surgical stress response and post-operative pain, reduce complications, improve post-operative outcomes, expedite recovery and decrease the length of hospital stay. It initially started with colorectal surgery, but now it is used in hepatobiliary, upper gastrointestinal system, urology, gynecology, vascular surgery, bariatric, and non-gastro intestinal specialties. Its role is well established in elective surgery. Now there are enough evidence suggesting its role in emergency surgeries as well. There are 24 elements of the ERAS bundle. However, only some critical elements of the ERAS bundle are feasible to be used in emergency surgery. Postoperative pain management is one of the significant elements in the ERAS bundle. Multimodal analgesia is the optimal modality for pain control. It facilitates early ambulation and rehabilitation. Current evidence recommends the ERAS protocol. However, each item within the protocol constantly changes over time, depending upon the evidence.