Hai-yuan LIU, Yuan REN, Da-wei SUN. Perioperative Management of the Program of Enhanced Recovery after Surgery in Gynecology[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 501-507. doi: 10.3969/j.issn.1674-9081.2018.06.005
Citation: Hai-yuan LIU, Yuan REN, Da-wei SUN. Perioperative Management of the Program of Enhanced Recovery after Surgery in Gynecology[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(6): 501-507. doi: 10.3969/j.issn.1674-9081.2018.06.005

Perioperative Management of the Program of Enhanced Recovery after Surgery in Gynecology

doi: 10.3969/j.issn.1674-9081.2018.06.005
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  • Corresponding author: SUN Da-wei   Tel: 010-69155749, E-mail: sundw1118@aliyun.com
  • Received Date: 2018-08-29
  • Publish Date: 2018-11-30
  • Enhanced recovery after surgery (ERAS) refers to a series of perioperatively optimized interventions based on evidence-based medicine, to reduce surgical stress and accelerate postoperative recovery of patients. The basic principles of ERAS include preoperative counseling, elimination of routine bowel preparation, preoperative carbohydrate uploading, multimodal analgesia, intraoperative temperature monitoring, optimized fluid infusion, avoidance of drainage placement, early postoperative feeding and ambulation. Studies have shown that ERAS can significantly shorten the length of hospital stay, reduce perioperative complications, save hospitalization expenditure, improve the patient's life quality, and may benefit patients in the long term. The successful implementation of ERAS requires combined efforts of multiple disciplines to develop a standard protocol for clinical practitioners, while the actual situation of each medical center and the specific condition of each patient should be fully investigated to achieve individualization and optimization at the same time.
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  • [1] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78:606-617. doi:  10.1093/bja/78.5.606
    [2] Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery(ERAS(R)) Society recommendations[J]. World J Surg, 2013, 37:259-284. doi:  10.1007/s00268-012-1772-0
    [3] Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy:Enhanced Recovery After Surgery (ERAS(R)) Society recommendations[J]. Br J Surg, 2014, 101:1209-1229. doi:  10.1002/bjs.9582
    [4] Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery:Enhanced Recovery After Surgery (ERAS(R)) Society recommendations[J]. World J Surg, 2013, 37:285-305. doi:  10.1007/s00268-012-1787-6
    [5] Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced Reco-very After Surgery (ERAS(R)) Society recommendations[J]. World J Surg, 2013, 37:240-258. doi:  10.1007/s00268-012-1771-1
    [6] Trowbridge ER, Dreisbach CN, Sarosiek BM, et al. Review of enhanced recovery programs in benign gynecologic surgery[J]. Int Urogynecol J, 2018, 29:3-11. doi:  10.1007/s00192-017-3442-0
    [7] Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology[J]. Gynecol Oncol, 2014, 135:586-594. doi:  10.1016/j.ygyno.2014.10.006
    [8] 中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志, 2016, 54:413-418. doi:  10.3760/cma.j.issn.0529-5815.2016.06.004
    [9] 陈凛, 陈亚进, 董海龙, 等.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志, 2018, 38:1-20. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsywkzz201801001
    [10] 国家卫生计生委医管中心加速康复外科专家委员会.中国肝移植围手术期加速康复管理专家共识(2018版)[J].中华普通外科杂志, 2018, 33:268-272. doi:  10.3760/cma.j.issn.1007-631X.2018.03.030
    [11] Nelson G, Dowdy SC, Lasala J, et al. Enhanced recovery after surgery (ERAS(R)) in gynecologic oncology-Practical considerations for program development[J]. Gynecol Oncol, 2017, 147:617-620. doi:  10.1016/j.ygyno.2017.09.023
    [12] Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation[J]. Cochrane Database Syst Rev, 2014, (3):D2294. doi:  10.1002/14651858.CD002294.pub3/abstract
    [13] Oppedal K, Moller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery[J]. Cochrane Database Syst Rev, 2012, (7):D8343. doi:  10.1002/14651858.CD008343.pub2/full
    [14] Kotze A, Harris A, Baker C, et al. British committee for standards in haematology guidelines on the identification and management of pre-operative anaemia[J]. Br J Haematol, 2015, 171:322-331. doi:  10.1111/bjh.13623
    [15] Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer[J]. Cochrane Database Syst Rev, 2006, (1):D5033. http://www.ncbi.nlm.nih.gov/pubmed/16437512
    [16] Tonia T, Mettler A, Robert N, et al. Erythropoietin or darbepoetin for patients with cancer[J]. Cochrane Database Syst Rev, 2012, (12):D3407. http://www.ncbi.nlm.nih.gov/pubmed/19588423
    [17] Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-An ESPEN Consensus Statement[J]. Clin Nutr, 2015, 34:335-340. doi:  10.1016/j.clnu.2015.03.001
    [18] Jie B, Jiang ZM, Nolan MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk[J]. Nutrition, 2012, 28:1022-1027. doi:  10.1016/j.nut.2012.01.017
    [19] Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters[J]. Anesthesiology, 2011, 114: 495-511.
    [20] Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery[J]. Cochrane Database Syst Rev, 2014, (8):D9161. doi:  10.1002/14651858.CD009161/full
    [21] Walker KJ, Smith AF. Premedication for anxiety in adult day surgery[J]. Cochrane Database Syst Rev, 2009, (4):D2192. http://www.ncbi.nlm.nih.gov/pubmed/10908527
    [22] Matsuo K, Yessaian AA, Lin YG, et al. Predictive model of venous thromboembolism in endometrial cancer[J]. Gynecol Oncol, 2013, 128:544-551. doi:  10.1016/j.ygyno.2012.12.014
    [23] Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data[J]. Medicine (Baltimore), 1999, 78:285-291. doi:  10.1097/00005792-199909000-00001
    [24] Sweetland S, Green J, Liu B, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women:prospective cohort study[J]. BMJ, 2009, 339:b4583. doi:  10.1136/bmj.b4583
    [25] UK NCGC. Venous Thromboembolism:Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital[M]. London:Royal College of Physicians (UK), 2010.
    [26] 郎景和, 王辰, 瞿红, 等.妇科手术后深静脉血栓形成及肺栓塞预防专家共识[J].中华妇产科杂志, 2017:649-653. doi:  10.3760/cma.j.issn.0529-567x.2017.10.001
    [27] Einstein MH, Kushner DM, Connor JP, et al. A protocol of dual prophylaxis for venous thromboembolism prevention in gynecologic cancer patients[J]. Obstet Gynecol, 2008, 112:1091-1097. doi:  10.1097/AOG.0b013e31818b1486
    [28] Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy:American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition)[J]. Reg Anesth Pain Med, 2010, 35:64-101. doi:  10.1097/AAP.0b013e3181c15c70
    [29] Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection[J]. Cochrane Database Syst Rev, 2011, (11):D4122. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM16856029
    [30] Hawn MT, Richman JS, Vick CC, et al. Timing of surgical antibiotic prophylaxis and the risk of surgical site infection[J]. JAMA Surg, 2013, 148:649-657. doi:  10.1001/jamasurg.2013.134
    [31] Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery:a randomized clinical trial (LAFA-study)[J]. Ann Surg, 2011, 254:868-875. doi:  10.1097/SLA.0b013e31821fd1ce
    [32] Yoong W, Sivashanmugarajan V, Relph S, et al. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study[J]. J Minim Invasive Gynecol, 2014, 21:83-89. doi:  10.1016/j.jmig.2013.06.007
    [33] Sessler DI. Perioperative thermoregulation and heat balance[J]. Lancet, 2016, 387:2655-2664. doi:  10.1016/S0140-6736(15)00981-2
    [34] Gan TJ, Diemunsch P, Habib AS, et al. Consensus guide-lines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2014, 118:85-113. doi:  10.1213/ANE.0000000000000002
    [35] Cheatham ML, Chapman WC, Key SP, et al. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy[J]. Ann Surg, 1995, 221:469-476, 476-478.
    [36] Cutillo G, Maneschi F, Franchi M, et al. Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery:a randomized study[J]. Obstet Gynecol, 1999, 93:41-45. http://www.sciencedirect.com/science/article/pii/S0029784498004013
    [37] Jesus EC, Karliczek A, Matos D, et al. Prophylactic anastomotic drainage for colorectal surgery[J]. Cochrane Database Syst Rev, 2004, (4):D2100. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011395/
    [38] Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal sur-gery:a systematic review and meta-analyses[J]. Ann Surg, 2004, 240:1074-1084, 1084-1085. doi:  10.1097/01.sla.0000146149.17411.c5
    [39] Charoenkwan K, Kietpeerakool C. Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphocyst formation in women with gynaecological malignancies[J]. Cochrane Database Syst Rev, 2017, (6):D7387. doi:  10.1002/14651858.cd007387.pub4
    [40] Straube S, Derry S, McQuay HJ, et al. Effect of preoperative Cox-Ⅱ-selective NSAIDs (coxibs) on postoperative outcomes:a systematic review of randomized studies[J]. Acta Anaesthesiol Scand, 2005, 49:601-613. doi:  10.1111/j.1399-6576.2005.00666.x
    [41] Nelson G, Dowdy SC, Lasala J, et al. Enhanced recovery after surgery (ERAS(R)) in gynecologic oncology-Practical considerations for program development[J]. Gynecol Oncol, 2017, 147:617-620. doi:  10.1016/j.ygyno.2017.09.023
    [42] Hristovska AM, Kristensen BB, Rasmussen MA, et al. Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy:a randomized, placebo-controlled trial[J]. Acta Obstet Gynecol Scand, 2014, 93:233-238. doi:  10.1111/aogs.12319
    [43] Kristensen BB, Rasmussen YH, Agerlin M, et al. Local infiltration analgesia in urogenital prolapse surgery:a prospective randomized, double-blind, placebo-controlled study[J]. Acta Obstet Gynecol Scand, 2011, 90:1121-1125. doi:  10.1111/j.1600-0412.2011.01234.x
    [44] Sprung J, Sanders MS, Warner ME, et al. Pain relief and functional status after vaginal hysterectomy:intrathecal versus general anesthesia[J]. Can J Anaesth, 2006, 53:690-700. doi:  10.1007/BF03021628
    [45] Wu CL, Cohen SR, Richman JM, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids:a meta-analysis[J]. Anesthesiology, 2005, 103:1079-1088, 1109-1110. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM16249683
    [46] Jorgensen H, Fomsgaard JS, Dirks J, et al. Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy[J]. Br J Anaesth, 2001, 87:577-583. doi:  10.1093/bja/87.4.577
    [47] Ferguson SE, Malhotra T, Seshan VE, et al. A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery[J]. Gynecol Oncol, 2009, 114:111-116. doi:  10.1016/j.ygyno.2009.03.014
    [48] Hubner M, Blanc C, Roulin D, et al. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway[J]. Ann Surg, 2015, 261:648-653. doi:  10.1097/SLA.0000000000000838
    [49] Massicotte L, Chalaoui KD, Beaulieu D, et al. Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy[J]. Acta Anaesthesiol Scand, 2009, 53:641-647. doi:  10.1111/j.1399-6576.2009.01930.x
    [50] Catro-Alves LJ, De Azevedo VL, De Freitas BT, et al. The effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy:a prospective, randomized, controlled trial[J]. Anesth Analg, 2011, 113:1480-1486. doi:  10.1213/ANE.0b013e3182334d8b
    [51] Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy[J]. Anesth Analg, 2008, 107:2056-2060. doi:  10.1213/ane.0b013e3181871313
    [52] Zohar E, Fredman B, Phillipov A, et al. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy[J]. Anesth Analg, 2001, 93:482-487, 4t. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW201705250200525
    [53] Bertoglio S, Fabiani F, Negri PD, et al. The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anes-thetics after colorectal cancer surgery:a randomized cont-rolled multicenter study[J]. Anesth Analg, 2012, 115:1442-1450. doi:  10.1213/ANE.0b013e31826b4694
    [54] Kushner DM, LaGalbo R, Connor JP, et al. Use of a bupivacaine continuous wound infusion system in gynecologic oncology:a randomized trial[J]. Obstet Gynecol, 2005, 106:227-233. doi:  10.1097/01.AOG.0000171111.68015.af
    [55] Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology[J]. Gynecol Oncol, 2014, 135:586-594. doi:  10.1016/j.ygyno.2014.10.006
    [56] Sachdeva A, Dalton M, Amaragiri SV, et al. Graduated compression stockings for prevention of deep vein thrombosis[J]. Cochrane Database Syst Rev, 2014, (12):D1484. doi:  10.1002/14651858.cd001484.pub3
    [57] Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery[J]. Cochrane Database Syst Rev, 2009, (1):D4318. http://www.ncbi.nlm.nih.gov/pubmed/19160234
    [58] Kiran RP, Turina M, Hammel J, et al. The clinical significance of an elevated postoperative glucose value in nondi-abetic patients after colorectal surgery:evidence for the need for tight glucose control?[J]. Ann Surg, 2013, 258:599-604, 604-605. doi:  10.1097/SLA.0b013e3182a501e3
    [59] Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery:A Review[J]. JAMA Surg, 2017, 152:292-298. doi:  10.1001/jamasurg.2016.4952
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