Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

Table 1

ERAS protocol.

Preoperative factors
High protein diet	Starting at appointment date	Up to 1 gr/kg, protein/day
Immunonutrition	Five days prior to surgery	Ensure complete liquid 1 can BID, Juben power BID
Clear liquids only	After midnight on day prior to surgery	Gatorade lemon-lime 20 Oz, no cream, no red drinks
Last intake	Three hours prior to surgery	Gatorade lemon-lime 20 Oz
Intraoperative factors
Pain control	Throughout the case	Epidural (optional), gabapentin 600 mg once
Normothermia	Throughout the case	Bair Huger
Fluid resuscitation	Throughout the case	Lidco monitor
Postoperative factors
Pain control	Throughout postoperative time	Avoid narcotic use, gabapentin 600 mg PO q 8 hrs × 3, Toradol 15 mg IV q 6 hrs × 4, Tylenol 1,000 iv as needed
Bowel regimen	Until return of bowel function	Colace 100 mg PO q 12 hrs, Dulcolax suppository 10 mg PR q 24 hrs
Diet	Early enteral nutrition	Immunonutrition × 5 days, diet as tolerated on POD1
Early convalescence	Postop day 0	Up to chair 6–8 hrs, ambulation in the halls 5 times a day
Drain management	Postop days 0-1	NGT removed on postoperative days 0-1