Table 1 The components of enhanced recovery after surgery and conventional recovery after surgery protocols

Preadmission

Out-patient appointment

• Surgical decision validation

• Imaging—X-rays, CT, MRI and neurophysiology if used

• Medical history

• Medication modification or cessation

• Blood tests

• Smoking cessation

Completed in hospitalization

[26,27,28]

Patients education

• Surgical expectation setting provided by surgeon

• ERAS education by fast-tracking nurses

• Handout including ERAS aims, analgesia, modern fasting, surgical technique, Rehabilitation goals, discharge criteria and follow-up plan

General informed consent without ERAS education

[13]

Preassessment Surgical Unit

• Anesthetist consultation

• ASA

• Feedback by nurse or anesthetist to surgeon

Not conventionally operated 

[26]

Preoperative

Modern fasting

Solids until 6 h and clear liquids (CHO beverage, Outfast) until 2 h prior to surgery

Fasting 8 h

[29]

Preemptive analgesia

Celecoxib (200 mg) and pregabalin (75 mg) given orally in the holding area

Not conventionally used

[30,31,32,33]

Antimicrobial prophylaxis

Cefuroxime (1.5 g) given 30 min prior to incision

Not performed at a consistent time

[34]

intraoperative

PONV prophylaxis

5-HT receptor antagonist (ramosetron) administrated during anesthetic induction

No routinely administrated

[28]

Tranexamic acid

1 g bolus prior to incision followed by 0.5 g/hour infusion

Not conventionally used

[35]

Steroid

Intravenous dexamethasone (10 mg) given prior to incision

Not conventionally used

[27]

Normovolemia maintenance

Intraoperative goal-directed fluid administration, administer vasopressors to support blood pressure control

Caregiver preference

[36]

Normothermia maintenance

Core temperature was maintained above 36℃ by using convective warming device

Performed using blankets

[37]

Foley catheter

Catheterization under anesthesia

Catheterization before anesthesia

[27]

MIS techniques

• Microscope assisted surgery

• Self-retaining retractors were used

No microscope

Traction by assistants

[2, 30]

Local analgesia

Local infiltration of incision at the end of surgery

Rarely used

[30]

postoperative

MMA

Opioid sparing, intravenous parecoxib 40 mg after surgery, celecoxib 200 mg and pregabalin 75 mg every 12 h as oral intake tolerated, intramuscular tramadol 100 mg if pain was poorly controlled

Caregiver preference

[30]

Early ambulation

Handouts including mobilization methods and goals provided by caregivers, patients encouraged to get out of bed on POD 1

Not provided handouts,

patients required to have

bed rest on POD 1–3

[26, 27, 30]

Early oral intake

Clear liquids permissible on POD 0. Patients encouraged to have oral diet at will after recovery from anesthesia

Not provided clear liquids

[30]

Early removal of Foley catheter

Removing the Foley catheter at POD 1

Extraction time depends on clinicians

[27]

Early removal of drain

POD 2

Clinicians' preference

[30]

Discharge criteria

Mobilization with help; adequate pain control (NRS < 3), toleration of oral intake, normal body temperature, no wound infection; and no severe complications

Experience judgment of clinicians

[38]

follow-up

• A mobile app was used for keeping contact with patients

• Postoperative fixed time was followed up, including NRS, NDI and JOA scores

Patients went to the hospital for reexamination

[26]