Table 1 The basic components of the multi-disciplinary ERAS pathway

Preoperative

Educational program

(1) Understand the patient, assess the condition

(2) Psychological, nutrition, surgery, rehabilitation education

(3) Good communication

(4) Emphasize active function exercise

(5) Advocate deep breathing, upper limbs pull rings, and other cardiopulmonary exercise

Management of nutrition

(1) If there is hypoalbuminemia and severe anemia, actively look for the original disease and correct it

(2) When necessary, human serum albumin 10 g Ivgtt

(3) Megaloblyte anemia: folate 5–10 mg Po Tid+ vitamin B12 0.5 mg Im Tiw

(4) Iron deficiency anemia: EPO 10,000 IU Ih Tiw+ ferrous succinate 0.2 g Po Tid

Management of dietary

(1) Eat a high protein diet

(2) Before anesthesia 6 h fast protein liquid (such as milk, broth)

(3) Before anesthesia 4 h fast carbohydrates (such as rice porridge, steamed bread)

(4) 2 h before anesthesia, do not drink clear liquid

(5) When necessary, 250–500 ml glucose was dropped 2–3 h before operation

Management of sleep

(1) Sedative hypnotic or anti-anxiety drugs

Management of pain

(1) Routine use of anti-inflammatory analgesics such as celecoxib 200 mg Po Bid

Intraoperative

Selection of anesthesia

(1) General anesthesia (laryngeal mask or endotracheal intubation)

(2) Combined with local infiltration anesthesia: ropivacaine 200 mg + 80 ml saline was injected into the incision and surrounding deep needle

Control of bleeding

(1) Blood pressure control: systolic blood pressure control in 90–110mmhg

(2) Bleeding control: 5–10 min before skin incision, tranexamic acid should be dropped 15–20 mg/kg

Management of body temperature

(1) Monitor and dynamically adjust the operating room temperature, do a good job of keeping warm

(2) Reduce limb exposure, for patients covered inflatable heating blanket

(3) The infusion of liquid will be first heated to 37 °C

Prevention of infection

(1) Ensure the operating room environment, control the number of patients involved in the operation

(2) Strict disinfection towel, as far as possible to shorten the operation time and reduce the surgical trauma, the operation field repeatedly rinse

(3) Preoperative 0.5–2 h intravenous antibiotics

(4) If the operation time exceeds 3 h, or blood loss > 1500 ml with the second dose

(5) The effective coverage time of antibacterial drugs includes the whole surgical process and 4 h after surgery, and the total prevention time is no more than 24 h

Postoperative

Management of anesthesia

(1) General anesthesia wake up: drink water before eating

(2) Moxapride 5 mg Po Tid to improve gastrointestinal motility

(3) Selection of anesthesia

Management of rehydration

(1) Avoid a large amount of fluid replacement: infusion volume from 25 to 40 ml (kg/day) is appropriate

(2) Control the infusion speed: the infusion speed of elderly patients is from 100 to 120 ml/h is appropriate

(3) Monitor blood routine, liver function, kidney function, and cardiac function indicators

Management of drainage tube

(1) No drainage or catheter was placed

Control of nausea and vomiting

(1) Intraoperative intravenous use of dexamethasone 10 mg

(2) Use ondansetron when necessary

Management of sleep

(1) Sedative hypnotic or anti-anxiety drugs

Management of pain

(1) Use of automatic analgesia pump for 3 days

(2) Sequential use of anti-inflammatory and analgesic drugs, such as celecoxib 200 mg Po Bid (recommended reduction of 50% for liver damage and elderly patients)

Management of activity

(1) Emphasis on early hip, knee, and ankle active flexion and extension function exercise, to increase muscle strength

(2) Exercise passive joint flexion and extension of hip, knee, and ankle joints with the help of the physician and CPM, at least three times a day, at least 15 min each time

(3) Asked frequently turn over, clap back

(4) Acupuncture

(5) Manipulation

(6) Oral traditional Chinese medicine