Enhanced Recovery After Surgery (ERAS): Protocols in Post-Mastectomy Breast Reconstruction

Abstract

Enhanced recovery after surgery (ERAS) protocols have become common for patients undergoing breast reconstruction, catalyzed by the recent opioid crisis. Here, we review standard ERAS protocol structure and the supporting evidence. A perioperative multidisciplinary team and multimodal pain management appropriately are the two critical factors for ERAS success. Preoperative counseling, both antibiotic and venous thromboembolic prophylaxis, and multimodal antiemetics are crucial to optimize results. Regional nerve blocks provide an alternative to oral and intravenous opioids. Intraoperative minimization of inhaled anesthetics and complete IV analgesia is recommended along with team communication. A postoperative opioid-sparing approach with medications such as acetaminophen, NSAIDs, and gabapentin is needed along with an early diet, patient mobilization, and IV fluid and Foley catheter discontinuation. ERAS protocols for breast reconstruction have shown a decrease in length of stay, intraoperative and postoperative narcotic use, and perioperative costs while simultaneously increasing patient satisfaction.