Laparoscopic ERAS

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 4 – P O S T O P E R AT I V E C A R E

Laparoscopic ERAS: Perioperative Management & Enhanced Recovery Bryant-Smith A et al. Life in the laparoscopic fast lane: evidence-based perioperative management and enhanced recovery in benign gynaecological laparoscopy. TOG 2021;23:113–123. doi:10.1111/tog.12723

34→20 hrs 78% 15×5mg LOS AFTER ERAS, LAP. HYSTERECTOMY PONV RISK, APFEL SCORE 4 OXYCODONE TABS MEET 75% NEEDS

DO N' T-M IS S FA C TS

  1. Caprini score ≥9 → 10.7% VTE risk, LMWH for 30 days; lap surgery scores 1pt (<45min) or 2pt (>45min).

  2. Diabetes: cancel surgery if urinary ketones >+++ or capillary ketones >3 mmol/L; target HbA1c <69 mmol/mol.

  3. Fasting: solids 6h, clear fluids 2h preoperatively. No routine bowel prep, even before bowel resection.

  4. Antibiotics only for ‘clean-contaminated’ ops (e.g. total hysterectomy): 2g cefazolin/1.5g cefuroxime + 500mg metronidazole IV; repeat if op >3h or blood loss >1500ml.

  5. Apfel score 4 (female + motion sickness/PONV Hx + non-smoker + planned opioids) = 78% PONV risk — typical laparoscopy patient.

  6. Oxycodone: 15 × 5mg tabs meets ≥75% of post-hysterectomy needs — do not over-prescribe.

  7. Trial of void success = PVR ≤100 ml or voiding ≥2/3 of total bladder volume; 2 failed attempts → discharge with catheter, repeat in 1 week.

  8. Day-1 fevers are usually unexplained (resolve by day 4); fevers ≥3 days post-op warrant infection work-up.

ANTITHROMBOTIC STOP TIMES (PILL LIST)

Warfarin: stop 5 days Apixaban/rivaroxaban: 48h (CrCl≥30) / 72h (CrCl<30) Dabigatran: 48–96h by CrCl Aspirin: continue

Clopidogrel: stop 7 days if not urgent

ABBREVIATION KEY

ERAS — enhanced recovery after surgery CXR — chest radiograph

VTE — venous thromboembolism INR — international normalised ratio

LMWH — low-molecular-weight heparin RCT — randomised controlled trial

NICE — National Institute for Health and Care Excellence SSI — surgical site infection

BV — bacterial vaginosis PONV — postoperative nausea and vomiting

MDT — multidisciplinary team NSAID — non-steroidal anti-inflammatory drug

BMI — body mass index POUR — postoperative urinary retention

ASA — American Society of Anesthesiologists PVR — post-void residual

FBC — full blood count HbA1c — glycated haemoglobin

CRP — C-reactive protein LOS — length of stay

ECG — electrocardiogram

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — benign gynaecological laparoscopy. TOG 2021;23:113–123. doi:10.1111/tog.12723

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