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Table 1 ERAS and general schedules for fractures around the elbow in children

From: Evaluation of open reduction of distal humerus fractures in children after implementation of an enhanced recovery after surgery program

 

ERAS schedules

General schedules

Admission

 Parent education

Dietary and analgesic guidance, and alleviation of parents’ anxiety

Conventional admission education

 Analgesia

Oral analgesia

No requirement

 Nutrition

Pediatric nutritional risk assessment (PNYS) and nutrition intervention

No requirement

 Detumescence

Elevation, cold compresses, fist-clenching guidance, without decongestants

Elevation and ice compresses in the presence/absence of decongestants, decided by surgeons

Before surgery

 Skin preparation

Preoperative skin cleaning without hair removal

No requirement

 Fasting and water deprivation time

No light drinking for 2 h, no breast milk for 4 h, no solid carbohydrates for 6 h, and no fat or protein intake for 8 h

Fasting and water deprivation for 8 h

 Carbohydrate loadinga

Intravenous infusion of 4:1 glucose and sodium chloride after fasting

Fluid supplementation for hungry pediatric patients

 Catheterization and intestinal preparation

No catheterization and intestinal preparation

Decided by surgeons

 Nerve block

Interscalene brachial plexus block

No requirement

During surgery

 Tubing and drainage

No incision drainage tube or reduction of other tubes

Drainage tube use decided by surgeons

 Body temperature

Contimuous body temperature monitoring and thermostatic blanket use during surgery

No requirement of continuous monitoring

 Reduce the risk of bleeding

Tourniquet use during surgery

No requirement

 Analgesia

Interscalene brachial plexus block, analgesic pump, and regular oral pain medications

Pain medication as required, an analgesic pump decided by parents, no requirement for nerve block

After surgery

 Food intake

Fasting after waking

Fasting and water deprivation after waking for 2 h

 Tube drawing

Drawing of infusion tube 1 day after surgery

Tube drawing time point decided by surgeons

 Nutrition

Reassessment and intervention after surgery

No requirement

 Carbohydrate loading

Discontinuation of parenteral nutrition 1 day after surgery

Energy supplement discontinuation time point decided by surgeons

 Postoperative dressing change and discharge

Dressing change on the 2nd and 4th days and discharge on the 4th day

Decided by surgeons

 

Removal of Kirschner wires and plaster as well as functional exercise guidance in the 4th–5th weeks

Removal time of fixtures decided by surgeons

Post-discharge compliance

Regular telephone and outpatient follow-up after discharge

Regular outpatient follow-up after discharge

  1. aWhether to give intravenous infusion during preoperative fasting