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.