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A Commonsense Patient-Centered Approach to Multimodal Analgesia Within Surgical Enhanced Recovery Protocols

Authors Mariano ER, Schatman ME

Received 15 November 2019

Accepted for publication 14 December 2019

Published 24 December 2019 Volume 2019:12 Pages 3461—3466


Checked for plagiarism Yes

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Edward R Mariano,1,2 Michael E Schatman3,4

1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 2Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; 3Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 4Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA

Correspondence: Edward R Mariano
Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801, Miranda Avenue (112A), Palo Alto, CA 94304, USA
Tel +1 650 849-0254
Fax +1 650 852-3423

“Enhanced recovery” in the context of a surgical patient is both a plan and a goal at the same time. The goal is faster convalescence after surgery with positive outcomes and no complications. The plan takes the form of an enhanced recovery protocol (ERP) or clinical pathway specific to a surgical procedure, a concept pioneered by Professor Henrik Kehlet from Denmark decades ago.1 Over time, this basic concept has evolved and has become arguably too complex. With over twenty elements frequently included in modern ERPs, it is not surprising that consistent implementation and adherence are lacking.2 Not all of these elements are critical, and a study of an ERP for bowel resection has demonstrated that three are particularly important: 1) laparoscopic (minimally invasive) approach; 2) early termination of intravenous fluid; and 3) early mobilization (getting out of bed).3

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