Table 1 Summary of the ERAS protocol used in the present study
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 10g Ivgtt | ||
(3) Megaloblyte anemia: folate 5-10mg Po Tid+ vitamin B12 0.5mg Im Tiw | ||
(4) Iron deficiency anemia: EPO 10,000 IU Ih Tiw+ Ferrous succinate 0.2g Po Tid | ||
Management of dietary | (1) Eat a high protein diet | |
(2) Before anesthesia 6h fast protein liquid (such as milk, broth) | ||
(3) Before anesthesia 4h fast carbohydrates (such as rice porridge, steamed bread) | ||
(4) 2h before anesthesia, do not drink clear liquid | ||
(5) When necessary, 250-500ml glucose was dropped 2-3h 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 200mg 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 0.5-2h intravenous antibiotics | ||
(4) If the operation time exceeds 3h, or blood loss > 1500ml with the second dose | ||
(5) The effective coverage time of antibacterial drugs includes the whole surgical process and 4 hours after surgery, and the total prevention time is no more than 24h | ||
Postoperative | Management of anesthesia | (1) General anesthesia wake up: drink water before eating |
(2) Moxapride 5mg 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 40ml (Kg/d) is appropriate | |
(2) Control the infusion speed: the infusion speed of elderly patients is from 100 to 120ml/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 three days | |
(2) Sequential use of anti-inflammatory and analgesic drugs, such as celecoxib 200mg 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 3 times a day, at least 15 minutes each time | ||
(3) Asked frequently turn over, clap back | ||
(4) Acupuncture | ||
(5) Manipulation |