Table 2 The ERAS protocol

Preoperative

 Inform the patient of her surgery and the protocol to be followed in the consultation

 Give up tobacco, alcohol, and ACHOs 4 weeks before surgery, correcting anemia

 Carbohydrate-rich diet the day before surgery

 6-h fast for solids and 2-h fast for clear liquid

 Abdominal and vaginal shaving (if necessary) of the patient

 No mechanical bowel preparation

Intraoperative

 Anesthetic induction and anesthetic maintenance with short-acting agents

 Maintain temperature 36 °C ± 0.5 (thermal blankets, hot sera)

 Pneumatic compression stockings

 Antibiotic prophylaxis

 Fluid therapy in continuous perfusion balanced solution (3–5 ml/kg/h for laparoscopy), maintain euvolemia

 Hemodynamic optimization through objective-guided fluid therapy (FGO) in risk patients

 Postoperative nausea and vomiting prophylaxis with double therapy

 No drainage, no nasogastric tube

 Infiltration of the laparoscopy ports with bupivacaine

Immediate postoperative

 Active temperature maintenance, maintenance of FiO₂ 0.5 2 h after the end of the operation

 Analgesia according to the operation, minimum morphic administration, avoid opiods

 Restrictive fluid therapy.

 Start of oral tolerance at 6 h postsurgery, if positive oral tolerance, liquid diet in the evening and removal of intravenous fluids

 Beginning of mobilization and prophylaxis of the thromboembolism at 6 h after surgery

Postoperative

 Blood test the morning after the intervention

 Normal balanced diet according to tolerance

 Removal of bladder catheter 12–24 h after surgery

 Active mobilization

 Oral analgesia according to protocol, avoiding morphs, breathing incentive

 Assess discharge from laparoscopic surgery (24–48 h)