Enhanced recovery pathways have become the established standard of care in many different areas of surgery.

Anaesthetists play a unique and vital role in the success of ERAS programmes in every speciality.

Fluid therapy and analgesia are two key areas of focus.

Individualised goal-directed fluid therapy has received a large amount of attention and whilst generated some controversy, there is no doubt that extremes of fluid balance will ultimately reduce tissue oxygen delivery either by poor cardiac output (too little fluid) or by oedema (excess fluid).

The key areas for analgesia are effective multimodal, opioid-sparing analgesia. The routine use of epidurals for these patients is increasingly debated.

The guideline linked below is a consensus paper, published in 2016.

It includes several recommendations to enhance recovery in patients undergoing gastrointestinal surgery. (Many of which can be applied to ERAS programs for all specialities)

Preoperatively: optimisation of medical disease and cessation of smoking and alcohol intake are emphasized.

Prevention of nausea and vomiting is an important element.

Careful titration of anaesthesia and ensuring full recovery of neuromuscular blockade are recommended.

The guideline also includes recommendations regarding fluid therapy, opioid-sparing analgesia and mobilisation.

Further reading:

Pathophysiology of Major Surgery and the Role of Enhanced Recovery Pathways and the Anesthesiologist to Improve Outcomes

Anaesthesia role in enhanced recovery after surgery: a revolution in care outcomes. Published in Current Opinion in Anaesthesiology Feb 2023

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