Enhanced recovery for non-colorectal surgery

Table 1 Types of Enhanced Recovery protocols adopted

	Preoperative	Intraoperative	Postop (first 24 h)	Day 1	Day 2	Day 3	Day 4	Additional comments
Kahokehr et al[7,8]	Routine nutritional assessment; nutrition supplementation; NBM 2 h preinduction; carbohydrate loading; no bowel preparation; functional assessment and goal setting	Thoracic epidural; short acting anesthetics; intraoperative fluids: 1000 mL of crystalloid and 500 mL of colloid; prophylactic antiemetics at induction (dexamethasone); no drains or NG tubes	All IV fluid stopped before patient discharged to ward; prophylactic antiemetics; early oral feeding; nutritional supplementation; no opioids	Removal of urinary catheter	Removal of epidural			Early mobilization and physiotherapy
King et al[9-11], Blazeby et al[12], Faiz et al[13]	Optimized pre-morbid health status; functional assessment and goal setting; Meeting with stoma nurse. Nutrition supplementation; bowel preparation (for left colonic, sigmoid and rectal tumours)	Thoracic epidural; intraoperative fluids: 2000 mL of crystalloid; minimal-access surgery; local anaesthetic infiltration to the largest wound; no drains or NG tubes	Free fluid; 1 high-protein/high-calorie drink; patient sat out in chair	All IV fluid stopped; regular paracetamol; 3 high-protein/high-calorie drink; normal diet offered; patient sat out in chair; start walking; removal of urinary catheter for colonic resections; laxatives	Removal of epidural; regular NSAIDS; Morphine for breakthrough	Removal of urinary catheter for rectal resections		Aim for discharge on day 3 for colonic or day 5 for rectal resection; Provision of hospital contact numbers, review on ward if problems within 2 wk; review in outpatient clinic on day 12
Jottard et al[14]	Functional assessment and goal setting; nutrition supplementation; no bowel preparation	Thoracic epidural; anti-thrombotic and infection prophylaxis; standard anesthetic protocol; prevention of intraoperative hypothermia; no drains or NG tubes	Free fluid	All IV fluid stopped; normal diet offered				Use of anti-emetics; early mobilization; postoperative nutritional care
Maessen et al[4,5], Nygren et al[3], Hendry et al[6]	Functional assessment and goal setting; nutrition supplementation; no bowel preparation	Thoracic epidural; prevention of intraoperative hypothermia; Transverse/curved incision	Oral analgesia; Patient sat out in chair; nutritional supplements; free fluid > 800 mL	All IV fluid stopped; nutritional supplements > 400 mL; normal diet offered; patient sat out in chair > 6 h	Removal of epidural; removal of urinary catheter
Soop et al[15]	Nutrition supplementation	Thoracic epidural	Prophylactic antiemetics	Regular paracetamol and NSAIDS; patient sat out in chair for 2 h	Patient sat out in chair for 4 h	Patient sat out in chair for 3 h	Epidural removed (at least)
Raymond et al[16]	Functional assessment and goal setting; nutrition supplementation	Thoracice epidural; Intra-operative targeted fluid management; No NG tube						Early mobilization/resumption of diet
Turunen et al[17]	Functional assessment and goal setting; preoperative feeding; bowel preparation	Thoracic epidural; high-oxygen P; prevention of hypothermia; no drains or NG tubes		Removal of urinary catheter				Early mobilization/resumption of diet; no routine opioids, regular; paracetamol and NSAIDS; fluid restriction
Senagore et al[18]		No NG tube	PCA; free fluids	Removal of urinary catheter; normal diet offered; regular NSAIDs, gabapentin, hydroxycodone if needed; no drains
Wennstrom et al[19]	Functional assessment and goal setting; no bowel preparation; preoperative oral hydration	Thoracic epidural; short acting anaesthetics; no opioids	Free fluid; patient sat out in chair		Epidural removed; urinary catheter removal
Mohn et al[20]	Functional assessment and goal setting; nutrition supplementation; bowel preparation.	Thoracic epidural; total intravenous anesthesia; intra-operative targeted fluid management; restricted postoperative intravenous fluids; routing antiemetics postoperatively; short midline incisions; No drains or NG tubes	Patient sat out in chair	Removal of urinary catheter; patient sat out in chair; normal diet offered; regular paracetamol and nsaids, opioids for breakthrough	Epidural removed			Regular laxatives twice daily; anti-thrombotic prophylaxis
Teeuwen et al[21]	Nutritional supplements; bowel preparation in left-sided resections; thrombotic prophylaxis	Thoracic epidural; transverse incisions except in Crohn’s disease and rectal surgery; intra-operative targeted fluid management (hypotension treated with vasopressors); no drains except in rectal surgery; no NG tubes; prophylactic antiemetics	Free fluids; nutritional supplements; patient sat out in chair	Normal diet offered; intravenous fluid administration; start walking	Epidural removed; urinary catheter removal; regular paracetamol; NSAIDs opioids for breakthrough
Ahmed et al[22,23]	Functional assessment and goal setting; nutritional supplements; no bowel preparation	High inspired oxygen; concentration; transverse incisions; no drains or NG tubes	Free fluids; soft diet offered; patient sat out in chair	Start walking				Regular paracetamol NSAIDs, opioids for breakthrough
Kirdak et al[24]	Thrombotic prophylaxis; bowel preparation; nutritional supplements	Thoracic epidural; pelvic drains with rectal dissections; urinary, central venous, and nasogastric catheters were routinely used	Start walking	NG tubes and urinary catheters removed (except pelvic dissection); soft diet offered; start walking; patient sat out in chair	Removal of urinary catheter (low pelvic operations) and drains	Epidural removed; regular paracetamol; central venous catheters removed; normal diet

NBM: Neuronal basal medium; NG: Nasogastric; NSAIDS: Nonsteroidal antiinflammatory drugs; PCA: Pyrrolidone carboxylic acid.