Enhanced recovery after gynaecological surgery

It is 07:15 before an abdominal hysterectomy. The patient expects days of fasting, tubes and bed rest. Your job is not to hurry her home. Your job is to remove every avoidable barrier to normal physiology, recognise complications early, and let recovery determine discharge.[1][2]

Overview and classification

ERAS is a multidisciplinary care system, not a single anaesthetic and not a short-stay promise. It joins patient education, anaesthesia, surgery, nursing, physiotherapy, nutrition, pharmacy and audit around shared recovery milestones.[1][2][3]

The classification that matters is core versus adapted. Core elements target stress, pain, nausea, ileus and immobility in almost every patient. Adapted elements respond to bowel resection, stoma, radical pelvic dissection, frailty, diabetes, chronic opioids or a genuine complication.[1][2]

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1. [1]Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I Gynecol Oncol, 2016.PMID 26603969
2. [2]Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II Gynecol Oncol, 2016.PMID 26757238
3. [3]Bisch SP, Wells T, Gramlich L, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes Gynecol Oncol, 2018.PMID 30100053
4. [4]Altman AD, Nelson GS The Canadian Gynaecologic Oncology Perioperative Management Survey: Baseline Practice Prior to Implementation of Enhanced Recovery After Surgery (ERAS) Society Guidelines J Obstet Gynaecol Can, 2016.PMID 27986184
5. [5]Ljungqvist O Preoperative carbohydrate loading in contrast to fasting JPEN J Parenter Enteral Nutr, 2010.PMID 20177852
6. [6]Ljungqvist O Modulating postoperative insulin resistance by preoperative carbohydrate loading Best Pract Res Clin Anaesthesiol, 2009.PMID 20108579
7. [7]Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Anesth Analg, 2020.PMID 32467512
8. [8]Bisch SP, Kooy J, Glaze S, et al. Impact of transversus abdominis plane blocks versus non-steroidal anti-inflammatory on post-operative opioid use in ERAS ovarian cancer surgery Gynecol Oncol, 2019.PMID 31515412
9. [9]Altman AD, Rozenholc A, Saciragic L, et al. The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations J Obstet Gynaecol Can, 2022.PMID 35750353
10. [10]Black KA, Nelson G, Goucher N, et al. Effect of transversus abdominis plane block on postoperative outcomes in gynecologic oncology patients managed on an Enhanced Recovery After Surgery pathway Gynecol Oncol Rep, 2023.PMID 37729808
11. [11]Gustafsson UO, Nygren J, Thorell A, et al. Pre-operative carbohydrate loading may be used in type 2 diabetes patients Acta Anaesthesiol Scand, 2008.PMID 18331374
12. [12]Tong E, Chen Y, Ren Y, et al. Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and Bayesian network meta-analysis of randomized controlled trials Int J Surg, 2022.PMID 36505254