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Table 1 Elements of enhanced recovery after surgery

From: Comparing the experience of enhanced recovery programme for gynaecological patients undergoing laparoscopic versus open gynaecological surgery: a prospective study

Pre-operative Intra-operative Post-operative
 •*Preadmission counselling  •Fluid and carbohydrate loading  •No prolonged fasting (clear fluids allowed up to 2 h before surgery)  •No/selective bowel preparation (to reduce the risk of post-operative ileus)  •Antibiotic prophylaxis  •Thromboprophylaxis  •**No premedication (by avoiding long acting pre-operative sedative pre-medication, the outcome of ERAS is enhanced by allowing early mobilisation, early oral intake in patients and early catheter removal)  •Short acting anaesthetic agents  •Regional analgesia  •Avoidance of drains  •Avoidance of salt and fluid overload  •Patient warming  •Avoidance of NG tubes  •Prevention of nausea and vomiting  •Minimal opioid analgesia  •Use of NSAIDs  •Early catheter removal  •Early oral nutrition (oral liquids are allowed on the night of surgery and light diet on post-operative day 1 with rapid progression thereafter)  •Early mobilisation (day 1 after surgery)  •Nurse led follow-up  •Audit of compliance and outcome
  1. *At preadmission counselling, patients undergoing a laparotomy had a face to face consultation with a physiotherapist whilst those having a laparoscopic surgery were given a leaflet on exercises that would have been taught by a physiotherapist
  2. ** Some patients were given premedication by their anaesthetist