Enhanced recovery after surgery: Current research insights and future direction

Table 2 Enhanced recovery after surgery society recommendations for colonic surgery and their evidence level[6]

ERAS element with high/moderate level evidence	ERAS element with low level evidence
Stopping smoking 4 wk prior to surgery	Pre-operative information and counselling
No routine use of bowel preparation	Stopping drinking alcohol 4 wk prior to surgery
Allowing clear fluids up until 2 h before and solids 6 h before anaesthetic induction	Peri-operative oral nutritional supplements and carbohydrate loading
No routine use of sedative premedication	Standard anaesthetic that allows rapid awakening
Routine thromboprophylaxis	Post-operative nausea and vomiting prophylaxis
Antimicrobial prophylaxis and skin preparation	Routine urinary drainage
Balanced intravenous fluids guided by flow measurements	Using stress reducing elements of ERAS to minimise hyperglycaemia
Use of mid thoracic epidural blocks in open surgery	Early mobilisation
Us of spinal analgesia or PCA in laparoscopic surgery
Laparoscopic surgery
No routine use of nasogastric tubes
Maintenance of normothermia
No routine intra-abdominal drains
Early post-operative enteral feeding
Insulin treatment of severe hyperglycaemia in ICU
Use of chewing gum to prevent post-operative ileus

ERAS: Enhanced recovery after surgery; PCA: Patient controlled analgesia; ICU: Intensive care unit.