Table 1 Enhanced recovery protocol for laparoscopic radical nephroureterectomy
Managements | pre-ERAS | ERAS |
|---|---|---|
Education | Routine preoperative education | More comprehensive preoperative education, including a rapid recovery program that guides patients to early eating and early activity, etc. |
Nurse | Primarily concerned with postoperative care operations | Focus on the entire perioperative care, including preoperative education and postoperative psychological and medical care |
Preoperative fasting (h) | 12 | 6 |
Preoperative water deprivation (h) | 4 | 2 (drink 300 ml of dross-free carbohydrate orally 2 h before surgery) |
Bowel preparation | Cleansing enema the night before and the morning of the operation | No enemas |
Postoperative fasting (h) | Until bowel movements resume | 6 after surgery |
Postoperative water deprivation | POD1 | Awakening from anesthesia |
Intraoperative intravenous fluid intake | General about 1500 ml | Communicate with anesthesiologist to minimize fluid input |
Postoperative intravenous fluid intake | Complete intravenous fluids on POD1; | Generally no more than 1000 ml on POD1; |
Intraoperative warming | Not emphasized | Preheat intravenous transfusion fluids or warm blankets |
Postoperative analgesia | Postoperative on-demand analgesia | Local anesthetic incision infiltration is used. Timely postoperative analgesia with NSAIDs, avoiding opioids as much as possible |
Postoperative activities | Rested in bed on the POD1. Usually walk on the POD2 or POD3 | Sit and walk on the POD1 |