ERAS Principles
Enhanced Recovery After Surgery (ERAS): evidence-based, multimodal, perioperative care pathway designed to achieve early recovery. Reduces: length of stay, complications, cost, readmissions. Goal: maintain physiologic function, minimize stress response, promote rapid return to baseline. Components: preadmission counseling, optimized nutrition, standardized anesthetic/surgical care, postoperative analgesia, early mobilization, early feeding. Protocols: colorectal, liver, pancreatic, gynecologic, urologic, orthopedic.
Key Elements
Pre-op: counseling, no prolonged fasting (clear liquids 2h, light meal 6h), carbohydrate drink, optimized nutrition, smoking/alcohol cessation, no bowel prep (or reduced), no premedication. Intra-op: short-acting anesthetics, regional anesthesia, minimally invasive surgery, goal-directed fluids, normothermia, no drains/tubes (minimize). Post-op: multimodal analgesia (opioid-sparing), early oral intake, early mobilization (POD0), gum chewing (ileus prevention), no routine NG, no routine drains, early catheter removal, discharge planning.
Nursing Role
Pre-op: education (ERAS pathway, expectations, goals), carbohydrate drink administration, verify NPO compliance (2h clear). Intra-op: maintain normothermia, minimize fluids, regional anesthesia. Post-op: multimodal analgesia (acetaminophen, NSAIDs, regional, minimize opioids), early mobilization (POD0 if possible), early feeding (within 24h), gum chewing, early catheter removal, no routine drains, discharge planning. Monitor: pain, PONV, intake, output, mobilization, complications. Document: ERAS compliance. Educate: patient and family on goals and pathway. Advocate: for protocol adherence.
Important Notes
- ERAS: no prolonged fasting — clear liquids up to 2h and light meal up to 6h before surgery. Carbohydrate drink before surgery.
- Early mobilization on POD0 (day of surgery) is a key ERAS principle — reduces complications and length of stay.
Clinical Tips
- Multimodal opioid-sparing analgesia is central to ERAS — acetaminophen, NSAIDs, regional anesthesia minimize opioids and PONV.
- Early feeding (within 24h) and gum chewing promote bowel function and reduce ileus — key ERAS elements.
Summary
ERAS protocols use evidence-based multimodal care: no prolonged fasting, carbohydrate loading, opioid-sparing analgesia, early mobilization, early feeding, and minimizing tubes/drains.
