Intervention
Interventions in both groups are
detailed in Table S1. Briefly,
patients were randomized into an
intervention group that was characterized by education in a full ERAS
program, with reduced preoperative fasting (including their last meal 6
hours before surgery and carbohydrate drink intake [300 mL or 5
mL/kg] 2 hours before surgery), omission of mechanical bowel
preparation (MBP) unless low anterior resection was planned, avoiding
pre-anesthetic medication, preoperative analgesia, total intravenous
anesthesia (TIVA), bispectral index (BIS) monitoring,
restricted intraoperative fluid
infusion, intravenous infusion of lidocaine, maintenance of
normothermia, prophylaxis of postoperative nausea and vomiting (PONV)
using ondansetron combined with dexamethasone, opioid-sparing multimodal
analgesia prescribed on a scheduled basis, catheter removal and
extensive ambulation, and oral intake starting on postoperative day
(POD) 0.
Patients allocated to the control
group had limited ERAS program counseling, complete preoperative fasting
with their last meal by midnight the day before surgery, no strict
restrictions on MBP or preanesthetic medication, intravenous-inhalation
combined anesthesia, restricted intraoperative fluid infusion,
intravenous infusion of lidocaine, maintenance of normothermia,
prophylaxis of PONV using ondansetron combined with dexamethasone,
catheter removal and progressive ambulation, oral intake starting on POD
1, necessary NSAID prescription, and opioids used for rescue or
breakthrough pain.
The design and implementation of
the ERAS program at our center was begun nearly a year before trial
initiation. Meetings were held every 2 weeks among the multiple
disciplines involved to guarantee compliance to the protocol. The
influence of the surgeon was minimized by limiting the performance of
all surgical cases to two operating surgeons.