Basic principles of anesthesia and postoperative analgesia in patients operated within an enhanced recovery after surgery (ERAS) protocol

Stanislav Slavchev, Angel Yordanov

Department of Gynecologic Oncology, Medical University Pleven, Pleven Bulgaria.

ABSTRACT

The Enhanced Recovery After Surgery (ERAS) system is a collection of preoperative, intraoperative, and early postoperative measures. The primary goal of gynecological surgery is a rapid and uneventful recovery from oncological and standard procedures, particularly in patients over the age of 65. The goal is to achieve comparable results to those obtained with minimally invasive procedures. Certain features of the ERAS system are similar to those of standard surgical procedures. These are the measures taken to prevent thromboembolism and to promote early postoperative mobility. Anesthesia and postoperative analgesia are critical components of achieving the ERAS system's objectives. The ERAS protocol requires multimodal non-opioid postoperative analgesia, infiltration of the surgical wound with a local anesthetic, and avoidance of opioid analgesics. We discuss current data on patient management according to the ERAS protocol for anesthesia and analgesia in order to minimize the body's stress reactions, promote early mobility, and reduce postoperative complications. ERAS protocol has gained popularity in recent years in a number of centers, primarily in the United States and Europe, due to its direct impact on hospital stay length, healthcare costs, and benefits for patients, their relatives, and caregivers.

Keywords:

ERAS protocol; multimodal opioid-sparing analgesia; local infiltration anesthesia