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Table 2 Perioperative care ERP interventions and definition of adherence

From: Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center

Preoperative

 Preadmission education

Patient received preoperative counselling from a nurse and a physician, and a dedicated booklet including information on recovery goals and expectation about hospital stay.

 Selective MBP

No MBP used for resection.

 Carbohydrate loading

Preoperative carbohydrate intake until 2 h before anaesthesia (50 g carbohydrate in 400 mL fluid).

 No long-acting sedation

No long-acting sedating medication used before surgery (e.g., opioids, antihistamines, benzodiazepines).

Intraoperative

 Antibiotic prophylaxis

Antibiotic prophylaxis completed prior to surgical incision

 IV Lidocaine

Continuous infusion: 1.5 mg/kg/h from the beginning to the end of surgery.

 Laparoscopic approach

Successfully completed laparoscopic resection.

 Zero Fluid Balanced

Intraoperative maintenance fluids, excluding replacement of blood loss: for laparoscopy: 3 ml/kg/h; for open surgery: 5 ml/kg/h.

 PONV

Multimodal prophylaxis administered, with at least to drugs including Dexamethasone.

 No abdominal or pelvic drainage

No resection-site drainage used.

 Normothermia

Body temperature measured at the end of surgery >36.0 _C.

 Preventive Opioid-sparing Multimodal

Acetaminophen, NSAIDs (unless complication), Nefopam: IV first dose administered intraoperatively.

Analgesia

Loco-regional analgesia performed (injection at incision site or bilateral TAP block).

Postoperative

 Opioid-sparing multimodal analgesia

Use of opioid-sparing strategies including, abdominal trunk block and oral analgesia: acetaminophen, NSAIDs (unless complication), Level II opioids.

 Free diet on POD 0

Patient received one meal with regular food by POD 0.

 Early mobilization out of bed on POD0

Patient mobilized out of bed after surgery by POD 0.

 Early ablation of IV fluid infusion

Ablation of intravenous fluid infusion by POD 0.

 Early removal of urinary drainage

Removal of urinary catheter by POD 1.

 TED prophylaxis

TED prophylaxis with low molecular weight heparin.

 Avoidance of nasogastric tube

Nasogastric tube removed at the end of general anaesthesia.

  1. Abbreviations: MBP mechanical bowel preparation, PONV prevention of nausea and vomiting