Table 2 Pre-, intra- and postoperative fast-track procedures
From: Fast-track protocols for patients undergoing spine surgery: a systematic review
Ref. | Preoperative | Intraoperative | ||||||
|---|---|---|---|---|---|---|---|---|
Patient education/ consultation | Physical therapy | Nutrition | Pain menagement | Pre-op day | Anesthesia/ pain menagement | Fluid and blood transfusion | Nausea-vomiting prophylaxis | |
Adeyemo et al. 2021b [16] | Behavioral health, no smocking. Psychology, nutrition, mineral metabolism, geriatrics (> 65 yr) consultation | Yes | Yes | NR | NR | Anesthesia, epidural controlled analgesia | TXA, normotension, transfusion protocol (fresh frozen plasma after each 3 units PRBC, Hb = 10 g/dL, platelets< 100,000/μl after every 5 units of PRBC, cryoprecipitate for fibrinogen< 100 mg/dL) | NR |
Adeyemo et al. 2021a [15] | NR | NR | NR | NR | NR | General anesthesia (endotracheal intubation), epidural patient-controlled analgesia (fentanyl 2 mg/mL, bupivacaine 0.625 mg/mL or 1.25 mg/mL at 6-8 mL/h, up to 2 mL boluses with lockout time of 15 min) | TXA, hemodynamic monitoring, cell saver blood salvage, fluid recovery (crystalloid, albumin, blood products) | NR |
Angus et al. 2019 [17] | General informations, no smoking. Multidisciplinary consultation, vitamin D control, visits to reduce anxiety | Therapy prehabilitation | NR | NR | Carbohydrate load | Anesthesia, analgesia (lignocaine infusions, pre-incision ketamine boluses) | NR | NR |
Brusko et al. 2019 [18] | NR | NR | NR | NR | NR | 20 mL liposomal bupivacaine injection and 20 mL bupivacaine hydrochloride | NR | NR |
Carr et al. 2019 [19] | General informations | NR | Nutrition and carbohydrate loading (300 ml clear, 2 h prior to hospital arrival and night before) | Multimodal analgesia (1 g acetaminophen the night before, 1.2 g gabapentin) | Multimodal analgesia (1 g acetaminophen the morning of surgery), active warming (prior to operating room), nasal povidone-iodine swab application | Total IV anesthesia (propofol, remifentanil to maintain), multimodal analgesia (0.5 mg/kg bolus ketamine and 0.5 mg/kg/h, IV acetaminophen at 6 h) | Normothermia (active warming with IV fluid warmers, covers, room temperature elevated prior to draping), fluid management (pulse pressure, stroke volume, cardiac output), TXA (1 g bolus prior to incision and 1 g over 8 h) | 4 mg IV ondansetron |
Chang et al. 2020 [20] | NR | NR | High protein diet, carbohydrate load | No narcotic medications | NR | IV anesthesia (propofol, ketamine, precedex, oxygen), multimodal analgesia (5-10 mL of 1:1 long-acting liposomal bupivacaine and 0.25% bupivacaine hydrochloride), no narcotic medications | NR | NR |
Chen et al. 2021 [21] | General informations. Immunological tests, blood biochemistry, and coagulation, urine and stool examinations, RX, CT, MRI | NR | Fasting | NR | Antibiotics | Standard anesthetic protocol | Drain | NR |
Dagal et al. 2019 [22] | General informations | NR | Nutritional support, carbohydrate loading | NR | NR | Anesthesia | GDHM, blood loss control (PPV, SVV, or CO), antifibrinolytics | NR |
d’Astorg et al. 2020 [23] | General informations. Multidisciplinary consultation | NR | NR | NR | Hospitalization | Anesthesia with multimodal analgesia (dexamethasone, ketamine, few morphine derivatives, local anaesthetics) | Smallest number of catheters and drains | Antiemetics |
Debono et al. 2019 [24] | General informations. Multidisciplinary consultation | NR | Modern fasting (until 6 h prior to surgery, clear liquids up to 2 h before, carbohydrate supplementation) | Limited premedication | Hospitalization, anti-infection prophylaxis | Short-acting anesthetics, pre-emptive analgesia | Use of drains limited | NR |
Debono et al. 2021 [25] | General informations. Multidisciplinary consultation | NR | Modern fasting | Taken limited medication | Hospitalization, anti-infection prophylaxis (disinfection protocol) | Pre-emptive analgesia | No drain | NR |
DeVries et al. 2020 [26] | General informations | NR | NR | NR | NR | Intrathecal morphine | NR | NR |
Duojun et al. 2021 [27] | Oral and written education. Psychological consultation | NR | Diet (no water deprivation), prevention of gastrointestinal reactions (serotonin receptor antagonists) | NR | Skin preparation, 0.07–0.08 mg/kg midazolam (1 h before, 0.05–0.06 mg/kg in patients > 60 yr), oral 400 mg celecoxib (200 mg in patients > 70 yr or with BMI < 25 kg/m2) | Local anesthesia (1% lidocaine with maximum amount of 300 mg, 4 mg IV ondansetron hydrochloride), analgesia (40 mg IV parecoxib sodium, local subcutaneous injection of ropivacaine) | Normothermia (36 °C, insulation blanket, heating fan), vascular condition control | 4 mg IV ondansetron hydrochloride |
Feng et al. 2019 [28] | General informations (handout) | NR | Fasting carbohydrate loading (6 h for liquids, 8 h for solid food and short-chain polypeptides drinks, 2 h for clear liquids) | NR | Pre-emptive analgesia (oral celecoxib 200 mg and pregabalin 150 mg 1 h before), antimicrobial prophylaxis (1.5 g cefuroxime 1 h before) | LIA (ropivacaine), catheters | TXA, normovolemia (goal-directed fluid administration), normothermia (> 36 °C, convective warming device) | NR |
Flanders et al. 2020 [29] | Written general information. Nutritional consultation (BMI < 18.5 or > 25 kg/m2 or with serum albumin < 3.5 g/dL), pain management (> 30 morphine equivalents of opioids for > 4 weeks), sleep medicine (scoring > 2 on the STOP-BANG questionnaire), endocrinology for clearance (serum glucose > 200 g/dL or HbA1c > 8%) | NR | Carbohydrate load (Gatorade, day before surgery and 2 h before arriving at hospital) | NR | NR | Multimodal analgesia (gabapentin with opioid and nonopioid analgesics) | NR | NR |
Fletcher et al. 2020 [30] | Pulmonology, gastroenterology, neurology and other specialists’ consultation | NR | NR | NR | NR | NR | NR | NR |
Fletcher et al. 2021 [31] | NR | NR | NR | NR | NR | NR | NR | NR |
Garg et al. 2021 [32] | General informations, no smoking and alcohol. Preanesthetic (HbA1c < 7 for diabetic patients) and nutritional (if BMI < 18.5 or > 30, hematinics for anaemia, protein supplementation for poorly nourished patients) consultation; bone mineral density evaluation (calcium and vitamin D supplementation, teriparatide injection, for osteoporotic patients) | Rehabilitation | Fasting (6 h before for solid food, 2 h before for clear liquids, IV 5% dextrose solution 500-1000 ml, overnight before surgery) | NR | Preemptive analgesia (75 mg oral pregabalin, 1000 mg acetaminophen, 2 h before surgery), chlorhexidine (4% the night before and morning of surgery), nasal swab (5 days before to detect Staphylococcus aureus, 2% nasal mupirocin, vancomycin) | Multimodal total IV anesthesia with < 0.5% MAC, avoidance of IV long-acting opioids, infiltration of subfascial local anesthetic drugs (0.25% bupivacaine before wound closure), antibiotic prophylaxis (cefuroxime injection), 2 to 3 of 3.5% povidone-iodine infused pulsatile lavage for wound | TXA bolus (20 mg/kg) and infusion (2 mg/kg/h), warmed IV fluids, invasive blood pressure monitoring, normothermia maintenance (> 36°, convection warmers) | 8 mg dexamethasone, 4 mg ondansetron (30 to 45 min before emergence from anesthesia) |
Gong et al. 2021 [33] | General informations. Nutritional (protein, glucose, omega-3 fatty acids, and specific amino acids, glutamine, arginine) consultation | NR | Fasting (4 h for liquids, 6 h for solid), carbohydrate loading (clear carbohydrate-rich drink 4 h before surgery) | Pre-emptive oral analgesics (celecoxib, eperisone, extended-release tramadol, pregabalin, on day of admission) | Antimicrobial prophylaxis (1.5 g cefuroxime 30 min before incision) | Surgical wound local anesthetic (skin blocks around the skin incision) | Normothermia (> 36 °C, air-warming device and warmed IV fluids), normovolemia (goal-directed fluid therapy) | NR |
He et al. 2020 [34] | NR | NR | NR | NR | TXA IV bolus 10 mg/kg (15 min before skin incision) | General anesthesia, TXA IV infusion 6-8 mg/kg/h (up to 15 mg/kg), drains | NR | NR |
Heo et al. 2019 [35] | General informations. Emotional support | NR | NR | NR | Pre-emptive analgesic (pregabalin 75 mg or gabapentin 300 mg), prophylactic antibiotic injection (first-generation cephalosporin), IV TXA, IV antiemetics | General or epidural anesthesia, local anesthetic injection, IV secondary prophylactic antibiotic injection, drainage catheter (epidural hematoma prevention), vancomycin local infiltration (over wound areas) | Maintain IV TXA | NR |
Ifrach et al. 2020 [36] | General informations and no smoking. Pain management (> 30 MED of opioids for > 4 weeks), sleep medicine (scoring > 2 on STOP-BANG questionnaire), endocrine clearance (serum glucose > 200 g/dl or HbA1c > 8%), nutritional consultation (BMI < 18.5 or > 25 kg/m2 or with serum albumin level < 3.5 g/dL) | NR | Carbohydrate load (gatorade, day before surgery and 2 h before arriving at hospital) | NR | NR | Anesthesia, multimodal pain therapy (gabapentin 600 mg at day 0), catheters limited | NR | NR |
Jazini et al. 2021 [37] | General informations and no smoking. Medical, cardiology, nutritional, pain management physicians consultations | NR | Yes | 600 mg gabapentin, 1000 mg acetaminophen, 200 mg celecoxib, 750 mg methocarbamol, 15 mg extended-release morphine | Carbohydrate rich drinks the night before surgery and 4 h prior to surgery, clear liquids until 2 h prior to surgery | Anesthesia monitored (transversus abdominis plane blocks) or TIVA if necessary, antibiotics, local anesthetics, 0.25% bupivacaine with epinephrine (into local subcutaneous and intramuscular tissues), long-acting opioids, opioid patient-controlled analgesia, IV opioid analgesia for breakthrough pain | Normothermia (35 °C), 2 g IV magnesium bolus, 10 mg/kg TXA bolus (EBL > 200 cc), IV lidocaine and ketamine drips, normoeuvolemia (hemodynamic monitoring, goal-directed fluids, lactated ringers) | 4 mg ondansetron, scopolamine patch |
Julien-Marsollier et al. 2020 [38] | General informations | NR | Fasting minimization, systematic iron supplementation (if hemoglobin < 14 g dl-1), recombinant erythropoietin | Oral 800 mg gabapentin | Clear-liquid carbohydrate loading (apple juice and water until 2 h prior to surgery), antibiotics | Anesthesia (dexmedetomidine and ketamine) and maintenance (sevoflurane in a 50% mixture of O2/N2O, bispectral index values 40–60), nonopioid analgesia (30 min before the end of surgery, IV or oral paracetamol 15 mg kg-1 6 h, IV ketoprofen 1 mg kg − 1 8 h or oral ibuprofen 10 mg kg − 1 6 h, nefopam 0.25 mg kg − 1 6 h, dexamethasone 0.15 mg kg − 1, 5μgkg − 1 intrathecal morphine) | TXA 10 mgkg − 1 and continuous infusion of 5mgkg − 1 h − 1, muscle relaxant, maintenance IV fluid (Ringer’s lactate), normothermia (36.5°-37 °C, double warmer system), sufentanil boluses (arterial pressure and heart rate within 20% of preoperative values), transfusion target Hb = 8gdL − 1 | Ondansetron 0.1 mg kg − 1 8 h |
Kalinin et al. 2021 [39] | General informations and no smoking. Anesthesiologist consultation | NR | Fasting | Avoid premedication | Solid food 6 h before surgery, fluids 2 h before, antibiotic prophylaxis (2 h before the first incision) | Dexmedetomidine (to control depth of anesthesia), sugammadex (for fast and effective reversal of the neuromuscular block upon patient extubation), local anesthetics infiltration (around surgical wound before suturing), multimodal analgesia (NSAIDs prior to skin incision and suturing) | NR | Compression hosiery, ultrasound examination of lower limb veins (before and next day after surgery) |
Kerolus et al. 2021 [40] | General informations | NR | Fasting | Pre-anesthetic medication, pregabalin 100 mg, oxycodone extended release 10 mg (> 75 yr old), baclofen 10 mg | NR | General anesthesia (ketamine, propofol or inhaled anesthetics as isoflurane or sevoflurane), IV opioids (fentanyl and its derivatives minimized), paralytics (if necessary), IV acetaminophen 1000 mg, local anesthetic 5–15-20 cc (0.25% ropivacaine with 1:100000 epinephrine, subcutaneously prior to closure), minimize drains | NR | 4 mg ondansetron, if necessary, every 6 h, 10 mg metoclopramide, if necessary, every 6 h |
Kilic et al. 2019 [41] | General informations. Anesthesiologists, surgeons, nurses, psychological consultation | NR | Fasting | NR | Antibiotic prophylaxis (30 min before incision), clear fluids up to 2 h and solid foods up to 4 h before surgery | TIVA (fentanyl 1 mg/kg and 2 mg/kg propofol), oxygen ventilation (endotracheal tube), anesthesia maintain (IV 2–4 mg/kg/hr. propofol), analgesia (30-ml bolus with 0.5% bupivacaine hydrochloride into subcutaneous tissue after closure, IV acetaminophen 1000 mg), no nasogastric tubes or catheter or drains | Fluid management restricted, systolic blood pressure, diastolic blood pressure, heart rate, and peripheral oxygen saturation monitoring (before and after anesthesia), normothermia (36 °C, convective warming devices), euvolemia (500 ml fluids), vasopressors (in case of hypotension) | IV 0.15 mg/kg ondansetron and 0.2 mg/kg dexamethasone |
Kilic et al. 2020 [42] | General informations and no smoking | Preconditioning exercises | NR | Upon arrival analgesia (oral gabapent 300 mg and acetaminophen 1000 mg), no opioids | Admission (same day of surgery), antibiotic prophylaxis (30 min before incision), clear fluids 2 h and solid food 4 h before surgery | TIVA (bispectral index monitoring and hypotensive anesthesia maintain), no opioid, 30 cc marcaine hydrochloride 0.5% into the subcutaneous tissues after wound closure, no nasogastric tubes or catheters or drains, ICU admissions minimized | IV 1.5 g TXA and topically 1 g in 100 mL saline during suturing and at the end of operation, fluid management and blood transfusions restricted (blood products minimized and transfusion if Hb < 8 g/dL), normothermia (convective warming devices) | IV 0.15 mg/kg ondansetron, 0.2 mg/kg dexamethasone |
Kim et al. 2021 [43] | General informations. Screening program, chronic pain service consultation | NR | NR | NR | NR | Anesthesia | Blood loss minimize (< 300-400 cc equivalent to 125 cc of cell saver blood return, 10 mg/kg TXA before incision and 1 mg/kg until closure, arterial pressures < 65, short-acting paralytic, local hemostatic agents collagen- and thrombin-based), transfusion minimize (EBL kept at 20% or less of the total blood volume) | NR |
Lampilas et al. 2021 [44] | General informations. Nurses and anesthetist consultation | Physiotherapy | Improved fasting and energy drink | NR | Hospitalization (1.30 h before surgery), energy drink (2 h before surgery) | Analgesic wound infiltration (2 mg/kg before incision), analgesic (remifentanil, ketamine, 0.15 mg/kg bolus morphin 1 h before end of surgery), hypnotic drugs (propofol, desflurane), catheter and drain avoided | TXA, hypothermia prevention | Dexamethasone, droperidol, zophren, if necessary |
Li et al. 2018 [45] | General informations on pain coping, discharge criteria andfollow-up informations | NR | No bowel preparation | NR | Fasting 6 h and water 2 h before, antimicrobial prophylaxis | Local anesthesia (0.75% ropivacaine), multimodal analgesia (IV NSAIDs, 40 mg parecoxib every 12 h or 100 mg flurbiprofen for 3 days and oral 100 mg celecoxib) | Operation room (25 °C) and body temperature maintenance (warm fluids air-warming devices) | 5-HT receptor antagonist |
Li et al. 2020 [46] | Verbal and handouts general informations. Nutritional consultation | NR | Fasting | NR | Clear fluids and carbohydrate drink up to 2 h before surgery, antimicrobial prophylaxis (within 1 h of incision) | TIVA (propofol, lidocaine, ketamine, ketorolac, antiemetics, up to 0.5% MAC inhaled anesthetics), LIA, multimodal analgesia | TXA, normothermia (36–37 °C), euvolemia (salt and water overload avoidance) | NR |
Li et al. 2021 [47] | Verbal and handouts general informations. Nutritional consultations | NR | Fasting | NR | Clear fluids and carbohydrate drink up to 2 h before surgery, antimicrobial prophylaxis (within 1 h of incision) | TIVA (propofol, lidocaine, ketamine, ketorolac, antiemetics, up to 0.5% MAC inhaled anesthetics), LIA, multimodal analgesia | TXA, normothermia (36–37 °C), euvolemia (salt and water overload avoidance) | NR |
Nazarenko et al. 2016 [48] | General informations. Neurosurgeon, anesthesiologist consultations | NR | NR | NR | Hospedalization | Regional anesthesia | NR | NR |
Rao et al. 2021 [49] | Education booklet | NR | Iron supplementation, multivitamin, bowel regimen (senna, 24 h before) | NR | Hospitalization, scopolamine patch, pregabalin or liquid gabapentin, antibiotic prophylaxis, cleansing (chlorhexidine) | Aminocaproic acid (bolus 100 mg/kg and infusion 10 mg/kg/h), epidural catheter, dexamethasone (prior to incision), IV acetaminophen (during closure) | Air warming blanket, IV fluid warmers | Ondansetron (prior to emergence for antiemesis) |
Shaw et al. 2021 [50] | NR | NR | NR | NR | NR | Methadone (29.5 MME, 0.5 MME/kg or 0.1 mg/kg) | NR | NR |
Smith et al. 2019 [51] | Education packet, antibiotics prophylaxis (ancef 2 g or 3 g if > 120 kg, clindamycin 900 mg, or vancomycin 15 mg/kg) | Yes | NR | NR | NR | Anesthesia, multimodal analgesia (acetaminophen 975 mg, gabapentin 900 mg, ketamine 30 mg IV for patients with >risk for pain), dexamethasone 8 mg IV after induction of anesthesia, antibiotics (1 h prior to incision), fentanyl, morphine, or hydromorphone, patient-controlled analgesia, methocarbamol 1500 mg IV | NR | Ondansetron 4 mg IV, oral aprepitant 40 mg for high-risk patients |
Soffin et al. 2019b [52] | General information. Multidisciplinary consultations | NR | NR | NR | Fasting (4 h for liquid, 6 h for solid), carbohydrate loading (12.5% maltodextrin-based drink 4 h before surgery), oral pre-emptive analgesia (oral 1000 mg acetaminophen and 300 mg gabapentin within 60 min of surgery), antimicrobial prophylaxis (within 1 h of incision) | TIVA with up to 0.5% MAC inhaled anesthetics (50-100 mg/kg/min propofol and 0.1–0.5 mg/min ketamine), non-opioid analgesia (15–30 mg ketorolac, 1–2 mg/kg/h lidocaine, LIA, ossicodone if necessary), no drain/catheter | Normothermia (convective warming, 36 °C), normovolemia (IV fluids) | 1.5 mg scopolamine transdermal, IV 4-8 mg ondansetron 30 min before, 4-8 mg dexamethasone |
Soffin et al. 2019a [53] | General informations | NR | Nutrition | NR | Solids until 6 h, clear liquids until 4 h prior to surgery, carbohydrate loading (4 h prior to surgery), antibiotic prophylaxis within 60 min of incision, pre-emptive analgesia (oral 1000 mg acetaminophen, 300 mg gabapentin) | TIVA (propofol 50–100 μg∙kg∙min − 1 and ketamine 0.1–0.5 mg∙min − 1, up to 0.5 MAC as needed, but avoid N2O), multimodal analgesia (lidocaine bolus 1 mg∙kg − 1 on induction and infusion 2 mg∙kg − 1 until closure of incision, ketorolac 15-30 mg during closure, IV acetaminophen 1000 mg), topical methylprednisolone prior to closure, no drain and catheter | Normothermia (36.0–37.0 °C, convective warmers), normovolemia (IV fluid warmer restriction 10–15 ml∙kg − 1), arterial pressure maintenance within 20% of baseline with ephedrine 5–10 mg IV doses as needed | 1.5 mg transdermal scopolamine, dexamethasone 4-8 mg, ondansetron 4 mg |
Soffin et al. 2019c [54] | General informations | NR | NR | NR | Oral 1000 mg acetaminophen and 300 mg gabapentin | General anesthesia (endotracheal intubation), premedication (midazolam 0.05 mg/kg), anesthetic induction (100% oxygen, 10 L/min, propofol 1.5–2 mg/kg, lidocaine 1.5 mg/kg, vecuronium 0.1 mg/kg, fentanyl 2 μg/kg), boluses fentanyl 1–2 μg/kg, or dilaudid up to 2 mg, propofol 50–150 μg/kg/h, ketamine (0.1–0.5 mg/min), lidocaine (2 mg/kg/h until closure of incision), isoflurane or sevoflurane up to 0.5 MAC as needed, mechanical ventilation (1:1 mixture of oxygen:air FiO2 50%, tidal volume 6–8 ml/kg, respiratory rate 8–14 titrated to an end-tidal carbon dioxide between 30 and 35 mmHg), residual neuromuscular blockade reversed with glycopyrrolate and neostigmine, IV labetalol 10 mg and/or propofol up to 50-mg bolus, and/or increased MAC inhaled anesthetics (if arterial pressure > 100 and/or heart rate 15% above baseline), opioids (fentanyl 1–2 μg/kg or dilaudid up to 2 mg if necessary) | Electrocardiography, blood pressure monitor, pulse oximetry, IV crystalloid solution (lactated Ringer’s solution 8–12 ml/kg/hr), arterial pressure within ±20% of each patient’s baseline value | IV 10 mg metoclopramide or ondansetron 4 mg, scopolamine 1.5 mg transdermally if refractory PONV, 4-8 mg dexamethasone, 4 mg ondansetron, 15-30 mg ketorolac during closure |
Soffin et al. 2020 [55] | Education module | NR | NR | NR | Fasting and 125-ml clear carbohydrate-rich beverage (4 h before), pre-emptive analgesia (oral 300 mg gabapentin, 1000 mg acetaminophen within 60 min), antimicrobial prophylaxis (within 1 h) | IV anesthesia (1–2 mg·kg-1 and 25-100 μg·kg·min-1 propofol, 0.1 mg·kg-1 vecuronium, up to 2 μg·kg-1 fentanyl, 0.1–0.5 mg·min-1 ketamine, 0.3–0.5 μg·kg·h-1 dexmedetomidine, infusions with isoflurane in oxygen-enriched air up to 0.3 minimum alveolar concentration), multimodal analgesia (IV 15-30 mg ketorolac, 1 mg·kg-1 lidocaine bolus and 2 mg·kg·h-1 infusion) | Normothermia (36–38°, forced-air warming blanket), normovolemia (warmed IV fluid) | Scopolamine patches (if high risk), 4-8 mg dexamethasone, 4 mg ondansetron |
Staartjes et al. 2019 [56] | General informations. Anesthesiologic screening, cardiologist, nutritional (BMI > 30 kg/m2) consultations | NR | NR | NR | Antimicrobial prophylaxis (broad-spectrum antibiotic), low-molecular-weight heparin | General anesthesia (propofol, sufentanil), LIA (2.5 mg/ml ropivacaine intramuscularly prior to incision), muscle relaxants limited | Hypothermia prevention (warm-air blankets), fluid imbalance and blood transfusion prevention, vasopressors, autologous cell-salvage | NR |
Venkata et al. 2018 [57] | General informations. Physician and anesthesiological consultations | NR | NR | NR | NR | General anesthesia, LIA (20 ml 0.25% bupvicaine during or after closure), multimodal analgesia (remifentanil hydrochloride, IV paracetamol, COX-2 inhibitor paracoxib sodium, small dose of morphine), antibiotic prophylaxis (1.5 g cefuroxime at induction anesthesia, chlorhexidine skin cleanse of operative site), no drain or catheter | No transfusion | NR |
Wang et al. 2017 [58] | General informations | NR | Enteral nutrition (protein uptake) | NR | Fasting (8 h for liquids, 12 h for solids), carbohydrate loading, antimicrobial prophylaxis and skin preparation (first-generation cephalosporin 1 h before incision, vaccination for MRSA) | Anesthesia (short-duration sedation, IV propofol and ketamine, oxygen), local analgesia (long-acting liposomal bupivacaine), osteobiologic adjuvants, no drains, catheter and narcotic medications | Normothermia and blood pressure maintain, fluid balance (cardiac output monitoring) | NR |
Wang et al. 2020 [59] | General informations | NR | Fasting, fluid and carbohydrate loading | NR | Antimicrobial prophylaxis | Standard anesthetic protocol, LIA | TXA, normothermia maintein | NR |
Yang et al. 2020a [60] | General informations | NR | Diet | NR | Clear liquid diet (day of surgery), neurontin (30 min before) | Intrathecal morphine (at the start of procedure) | NR | NR |
Yang et al. 2020b [61] | General informations. Nutrition and psychological consultations | NR | Increased albumin infusion and improved enteral uptake | Preemptive analgesia (muscle relaxant, NSAID, celecoxib, meloxicam, flurbiprofen, or tramadol), opioid restricted, respiratory infection prevention (gentamicin, mucosolvan and albuterol aerosol, twice a day for 2 days before the start of endotracheal anesthesia), pre-anaesthesia (1 day before anesthesia initiation) | Fasting (2 h for liquids, 6 h for solid food), carbohydrate loading (water for cases with diabetes), preventive analgesia (IV NSAID, 5 min before anesthesia induction) | General anesthesia (fentanyl, short-acting remifentanil if necessary), LIA (long-acting liposomal ropivacaine before wound suturing) | Multiple monitoring (electrocardiogram, blood pressure, arterial blood gas analysis, bispectral index, stroke volume variation, urinary volume, oxygen saturation and end tidal CO2), crystalloid solution infusion (1 − 2 ml/kg h with or without colloidal fluid), normothermia (warm draping, infused fluid heated, > 36 °C) | NR |
Yang et al. 2021 [62] | General informations. Cardiac and pulmonary function, nutritional status, mental health consultations | Preconditioning exercise (6 weeks before surgery), balloon blowing | NR | NR | Antibiotic prophylaxis (within 0.5-1 h of incision and additional antibiotic if operation time > 180 min), fasting (clear fluids up to 2 h and solids up to 6 h before anesthesia, carbohydrate-contained beverage or high-dose glucose infusion ≥5 mg/kg/min) | General anesthesia (IV propofol 1–2 mg/kg, midazolam 1–2 mg, sufentanil 0.3–0.6 mg/kg, rocuronium 0.6 mg/kg), multimodal analgesia IV (parecoxib 40 mg, oxycodone 0.1–0.2 mg/kg within 0.5 h of induction, remifentanil 0.1–0.3 mg/kg/min, dexmedetomidine 0.4 mg/kg/h, propofol 4-12 mg/kg/h, opioids, COX-2) inhibitor), subcutaneous drainage | Restricted fluid therapy, temperature management (36 °C, fluid warming, airway humidification, forced-air warming blanket), antipressure ulcers nursing (foam pads), blood management (hypotensive anesthesia with arterial pressure 70-75 mmHg, cell salvage, TXA 10-20 mg/kg before incision + 1 mg/kg/h infusion + 3 g topical application, blood products transfusion if Hb < 70 g/L) | Dual antiemetic prophylactic therapy with IV ondansetron 4 mg, dexamethasone 10 mg, or intramuscularly metoclopramide 10 mg |
Young et al. 2021 [63] | General informations and no smoking. Chlorhexidine for skin, screening for diabetes mellitus, malnutrition and methicillin-Staphylococcus aureus colonization, neuropsychology clinic, multidisciplinary anesthesia pain management | Yes | Standard bowel regimen, diet | NR | Analgesia (1 g acetaminophen, 600-1200 mg gabapentin 60 min before surgery), infection prophylaxis (2 g cefazolin or clindamycin/vancomycin 30-60 min before incision) | Local anesthetic (bupivacaine, and epidural morphine sulfate in nonfusion cases), catheter | NR | 10 mg dexamethasone |
Band et al. 2022 [64] | Optimization of chronic disease management (diabetes, hypertension), discussion regarding weight loss, no smocking, preoperative education, counseling, and hospital orientation session | NR | NR | Oral analgesics (acetaminophen 1 g, baclofen 10 mg, oxycontin 20 mg, gabapentin 300 mg) | NR | General anesthesia (midazolam, ketamine 0.5 mg/kg bolus up to max of 50 mg followed by 0.5 mg/kg/h, and/or dexmedetomidine infusion 0.4mcg/kg/h), dexamethasone 10 mg), subfascial drains, peri-incisional bupivacaine 0.5% 20Ml, urinary catheters | NR | Zofran 4 mg |
Chen et al. 2022 [65] | Education, assessment, diet management, smoking and alcohol cessation, psychological evaluation | NR | Fasting (6 h for liquids and 8 h for solid food), clear fluids, including carbohydrate drinks up to 2 h before | Oral celecoxib 200 mg and pregabalin 150 mg within 1 h before surgery | IV first-generation cephalosporin for 30 min before | Local anesthesia, long-acting opioids, anesthetic agents, and large doses of muscle relaxants avoided | Normothermia (heating device, 36 °C), goal-directed fluid administration, IV tranexamic acid (10-20 mg/kg load dose before resection followed by infusion at 1 mg/kg/h maintenance dose) | NR |
Leng et al. 2022 [66] | Education, consultation, smoking cessation | NR | Modern fasting (solids within 6 h and carbohydrate beverages within 2 h prior) | Oral celecoxib 200 mg, pregabalin 75 mg, acetaminophen 1 g, 1 h before | Antimicrobial prophylaxis (cefuroxime 1.5 g, 30 min before) | Anesthesia, local analgesia (5 mg/mL ropivacaine hydrochloride), catheter | TXA (1 g bolus followed by 0.5 g/h infusion), dexamethasone 10 mg, normovolemia (goal-directed fuid administration, vasopressors), normothermia (36 °C, convective warming device) | 5-HT receptor antagonist (ramosetron) |
Porche et al. b2022 [67] | Physical capacity, cognitive, cardiac, pulmonary, renal, pain, nutrition and risk evaluation, anemia and diabetes control, education, medical optimization, smoking cessation | NR | Clear liquids for 2 h and solid foods for 8 h cessation before | NR | Acetaminophen, duloxetine 60 mg, gabapentin, methadone (0.1–0.2 mg/kg with max 20 mg), antifibrinolytics | Induction and maintenance and airway management, total IV anesthesia if applicable, adjuvant pain management (dexmedetomidine, ketamine, lidocaine), IV methadone, no NSAIDs or steroids | Goal-directed fluid therapy, baseline ABG and TEG, colloids for boluses per EBL and SVV, transfuse packed red blood cells if Hb < 8 or < 9 in coronary artery disease patients, transfuse platelets and cryoprecipitate per TEG, avoid fresh frozen plasma unless indicated, normothermia (warm fluids and upper and lower body air-warming devices) | NR |
Porche et al. a2022 [68] | Physical capacity, cognitive, cardiac, pulmonary, renal, pain, nutrition and risk evaluation, anemia and diabetes control, education, medical optimization, smoking cessation | NR | Clear liquids for 2 h and solid foods for 8 h cessation before | NR | Acetaminophen, duloxetine 60 mg, gabapentin, methadone (0.1–0.2 mg/kg with max 20 mg), antifibrinolytics | Induction and maintenance and airway management, total IV anesthesia if applicable, adjuvant pain management (dexmedetomidine, ketamine, lidocaine), IV methadone, no NSAIDs or steroids | Goal-directed fluid therapy, baseline ABG and TEG, colloids for boluses per EBL and SVV, transfuse packed red blood cells if Hb < 8 or < 9 in coronary artery disease patients, transfuse platelets and cryoprecipitate per TEG, avoid fresh frozen plasma unless indicated, normothermia (warm fluids and upper and lower body air-warming devices) | NR |
Sun et al. 2022 [69] | Education, management of nutrition, dietary, sleep, pain and body temperature | NR | NR | NR | NR | NR | Liquid therapy | NR |
Wang et al. 2022 [70] | Patient education and counseling | NR | No prolonged fasting, eat up to 6 h before and carbohydrate drinks up to 2 h before | NR | Antibiotic prophylaxiswithin 1 h, TXA within half h | Multimodal analgesia, local infiltration analgesia (10 mL ropivacaine and 10 mL lidocaine) | Normothermia (convective warming, 36–37 °C) | NR |
Zhang et al. 2022 [71] | Counselling, education | NR | Fasting and water deprivation for 2 h | Analgesic therapy (oral etoricoxib 120 mg the day before surgery) | TXA | Continuous epidural anesthesia, no catheter | TXA, nerve electrophysiological monitoring | NR |
Ref. | Postoperative | |||||||
|---|---|---|---|---|---|---|---|---|
Mobilization | Pain regimen | DVT prophylaxis | Nutrition | Early drain/catheter removal | Antibiotic prophylaxis | Fluid | Discharge | |
Adeyemo et al. 2021b [16] | Day 1 | Multimodal analgesia, narcotic medication minimization | Compression stockings, low molecular weight heparin | Appropriate nutritional intake | NR | NR | NR | NR |
Adeyemo et al. 2021a [15] | NR | Epidural patient-controlled analgesia with catheter removal on day 3 (muscle relaxants, gabapentin, paracetamol, narcotic) | NR | NR | NR | NR | NR | NR |
Angus et al. 2019 [17] | Yes | Multimodal analgesia (patient-controlled analgesia opioids/ketamine and IV paracetamol) | Yes | Bowel regimen | Drain | Wound care | NR | Support line (a call at day 1 and 3 post discharge and clinic review at 6 days) |
Brusko et al. 2019 [18] | Physical therapy, occupational therapy | 1 g IV acetaminophen infusion, 5 mg–325 mg oxycodone-acetaminophen tablets | NR | NR | NR | NR | NR | Daily visits from the multidisciplinary team |
Carr et al. 2019 [19] | Day 2 | 8 mg/h ketamine (for the first 24 h after surgery), 1 g acetaminophen and 900 mg gabapentin (for 3 days) | NR | Oral intake and full diet | Day 2 (catheter) | NR | Maintenance IV fluids (2 ml/kg/h) | NR |
Chang et al. 2020 [20] | Yes | Standard and PRN opioid medications (percocet 5–325, tramadol, dilaudid IV) | NR | NR | NR | NR | NR | NR |
Chen et al. 2021 [21] | Yes | Multimodal analgesia | Yes | Early feeding, gastrointestinal management | Within 48 h (catheter and drain) | Antibiotics | NR | Visits, blood and coagulation examinations, blood biochemistry, RX, CT, RM, discharged 3–5 days after surgery |
Dagal et al. 2019 [22] | NR | Opioid-sparing multimodal analgesia (acetaminophen, gabapentin, ketamine) | NR | NR | NR | NR | NR | NR |
d’Astorg et al. 2020 [23] | Day 0 | Oral analgesia | NR | NR | Catheters and drains | NR | NR | Follow-up phone call (day 1), surgical consultation (4–6 weeks) |
Debono et al. 2019 [24] | Physiotherapy | Opioid-sparing multimodal approach (tramadol, NSAIDs, and oxycodone if necessary) | NR | Early oral feeding | After surgery (catheter) | NR | NR | Rapid discharge, online/phone survey, mobile app (15 days), surgical consultation (6 weeks) |
Debono et al. 2021 [25] | Physiotherapy | NR | NR | NR | NR | NR | NR | Day 1 (discharge), mobile app (15 days), surgical consultation (6 weeks), satisfaction phone survey, online clinical evaluation |
DeVries et al. 2020 [26] | Day 2 | Patient-controlled analgesia (acetaminophen, NSAID), oral opioids | NR | NR | Day 2 (catheter) | NR | NR | Day 3 |
Duojun et al. 2021 [27] | 3 h after surgery rehabilitation exercise: lumbar back muscle function | Multimodal and advanced analgesia (active administration, avoiding opioid use, NSAIDs use) | NR | Early high-quality diet | NR | NR | No rehydration | Within 3 days |
Feng et al. 2019 [28] | Day 1 | Opioid sparing multimodal analgesia (IV parecoxib 40 mg, oral celecoxib 200 mg every 12 h, oral pregabalin 75 mg every 12 h, if necessary intramuscular tramadol 100 mg) | NR | Early nutrition (clear liquids day 0, oral intake day 1), oral diet | After surgery (catheters) | NR | NR | NR |
Flanders et al. 2020 [29] | Within 6 h and ambulation 3 to 5 times daily (day 1) | Nonopioids, muscle relaxants, oral and IV opioids as needed | Active exercises | Nutrition, chewing gum and instructed to chew (1 piece 3 times per day to reduce the risk of ileus) | NR | Wound washing (for 2 weeks) | NR | NR |
Fletcher et al. 2020 [30] | Yes | IV enteral narcotic and antispasmodies (diazepam) | NR | Normal feeding with clear liquids | Day 1 (catheters and drains) | NR | NR | NR |
Fletcher et al. 2021 [31] | NR | Oral medication | NR | Regular diet | NR | NR | NR | Patient/family comfort with care plan |
Garg et al. 2021 [32] | Yes | Opioid-sparing multimodal analgesia (acetaminophen, pregabalin, and diclofenac for breakthrough pain, limited use of NSAIDs, avoidance of tramadol) | NR | Early enteral feeding and chewing gum | Drain avoided (if applied, removed between 24 and 36 h after surgery), catheterization avoided (if applied, removed day 1) | NR | IV fluids discontinued (within 6 h of surgery) | Early discharge, telephonic follow-up (48 h and 1 week after discharge) |
Gong et al. 2021 [33] | Day 1 | Multimodal analgesia (IV parecoxib, oral celecoxib, acetaminophen, and if necessary, pregabalin from day 1, IV or intramuscular morphine if necessary) | NR | Early (liquid food day 0, solid food day 1) | Day 1 (catheter and drain), drain output < 20 mL/24 h | NR | NR | NR |
He et al. 2020 [34] | NR | NR | Intermittent pneumatic compression device | NR | Drain (< 30 ml for 24 h) | NR | NR | NR |
Heo et al. 2019 [35] | Yes | IV patient-controlled analgesia, oral analgesic w/ pregabalin or gabapentin | Ambulation, anti-DVT stocking, intermittent pneumatic compression of legs | Early nutrition | NR | NR | NR | NR |
Ifrach et al. 2020 [36] | Within 6 h of surgery, ambulation (3–5 times daily ketorolac on day 1) | Pain management (acetaminophen 975 mg at day 0 every 6 h, IV ketorolac 15 mg as needed, muscle relaxants as cyclobenzaprine 10 mg and diazepam 5 mg as needed, oral opioid as oxycodone 5-10 mg or hydromorphone 2-4 mg at day 0 as needed, IV opioids as morphine 1–2 mg and hydromorphone 0.2–0.4 mg if necessary for breakthrough pain until day 1) | Sequential compression device, heparin every 8 h starting day 1 | Nutrition, chewing gum (1 piece 3 times per day, Senna 17.2 mg twice a day, polyethylene glycol as needed, to reduce the risk of postoperative ileus) | NR | Standard open wound care regimen (daily chlorhexidine bath beginning day 1) | NR | Primary care within 2 weeks from discharge |
Jazini et al. 2021 [37] | Day 0 | Multimodal analgesia every 8 h (300 mg gabapentin, 1000 mg acetaminophen, 750 mg methocarbamol, 20 mg famotidine), 5 mg oxycodone (1–3/10 pain), 10 mg (4–6/10 pain), 15 mg (7–10/10 pain), 8 mg hydromorphone for breakthrough pain, incentive spirometry 10 times every h | NR | Advanced diet, protein shakes, stool softeners | Day 1 (catheters) | NR | NR | Long and short-acting opioid medications and muscle relaxer after discharge |
Julien-Marsollier et al. 2020 [38] | Day 1 (physiotherapy) | Avoidance of continuous background morphine infusions with patient-controlled analgesia, opioid-sparing pharmacological and non-pharmacological techniques (cooling brace, 400 mg/day gabapentin for 5 days) | NR | Rapid feeding | Day 1 (drains), day 2 (catheters) | NR | IV fluid administration (balanced crystalloid solution at 2mlkg − 1 h − 1) | NR |
Kalinin et al. 2021 [39] | First h after surgery (rehabilitation), day 1 (physiotherapy) | Opioid sparing multimodal analgesia, recovery from post-anesthetic depression | Within first 12 h after surgery | NR | No drain or removal at day 1, catheter removal in operating room | NR | Within first 12 h after surgery | NR |
Kerolus et al. 2021 [40] | Day 0 and 1 (mobilization and aggressive physical therapy), cryotherapy (ice packs for 10-15 min 6 times per day, initiated in recovery room and for 72 h postoperatively) | Multimodal analgesia (acetaminophen 625 mg if pain score ≤ 3, hydrocodone-acetaminophen 5-325 mg if pain ≤4–6 every 4 h, hydrocodone-acetaminophen 10-325 mg if pain ≤7–10 every 4 h, tramadol 100 mg every 4 h, IV morphine 2-4 mg every 4-6 h, morphine patient-controlled analgesia, if necessary, pregabalin 75 mg) | Subcutaneous IV heparin at day 1 | Early nutrition (1 L normal saline), bowel regimen (docusate-sodium, senna-docusate 1 tablet scheduled at night, polyethylene glycol 1 tablet scheduled daily) | Catheter removal if placed (> 400 cc, if occurs 3 times in a row) | NR | Fluid management | Social work and nurse specialist rounds |
Kilic et al. 2019 [41] | Within 2 h | Opioid-sparing multimodal approach (acetaminophen used before an opioid analgesic, tramadol as rescue analgesia) | Low-molecular-weight heparin subcutaneously | Early oral intake | NR | NR | NR | NR |
Kilic et al. 2020 [42] | Day 0 with movements 3 times daily | Opioid-sparing approach (acetaminophen and NSAIDs with pain > 4, tramadol with pain > 8) | Low-molecular-weight heparin | Early food and drink intake | NR | NR | NR | NR |
Kim et al. 2021 [43] | Day 0 (physical therapy and rehabilitation) | Multimodal analgesia (ketorolac, acetaminophen, or IV hydromorphone patient-controlled analgesia for breakthrough pain at day 1), oral opioid, dexamethasone at day 2 | Day 0 (pharmacologic prevention) | Early bowel function return | Day 1 (catheters), Day 3 (drains, output < 80 cc/8-h) | NR | Minimizing blood transfusions | NR |
Lampilas et al. 2021 [44] | Day 0 | Oral multimodal analgesia (NSAIDs, muscle relaxants) | NR | Oral nutrition | Day 0, at the end of intervention (catheter), day 1 (drain) | NR | NR | X-ray control, follow-up |
Li et al. 2018 [45] | Day 1 | NR | Deep vein ultrasound (for high-risk patients), pneumatic pump, stretch socks | Day 0 (early oral food intake, regular diet) | Day 1 (catheter), day 2 (drain) | NR | Less infusion volume (1000mlx2 days) | NR |
Li et al. 2020 [46] | Within 4 h after surgery | Multimodal analgesia (no analgesia or oral minimal dose nonopioid with pain < 4, oral or IV nonopioid with pain 4–6, opioid with pain ≥7) | Limb movement, antithrombotic stockings | Early oral feeding | Catheter removal returning to the ward | NR | NR | NR |
Li et al. 2021 [47] | Within 4 h after surgery | Multimodal analgesia (no analgesia or oral minimal dose nonopioid with pain < 4, oral or IV nonopioid with pain 4–6, opioid with pain ≥7) | Limb movement, antithrombotic stockings | Early oral feeding | Catheter removal returning to the ward | NR | NR | NR |
Nazarenko et al. 2016 [48] | 2 h after surgery (rehabilitation) | Short-acting anesthetics | NR | Enteral nutrition | NR | NR | NR | 2–3 day after operation |
Rao et al. 2021 [49] | Yes | Epidural infusion 0.1% ropivacaine 0.2 cc/kg/h (maximum rate 10 cc/h), hydromorphone patien-controlled analgesia (discontinued day 2), nonopioid and opioid analgesics (ketorolac, diazepam, gabapentinoids, acetaminophen, oral pregabalin, oral ossicodone, naloxone, oral ibuprofen) | NR | Early nutrition, clear liquid, bowel regimen, stool softeners, chewing gum | Day 2 (epidural catheter) | Antibiotics | NR | Follow-up (3–4 weeks), oral opioids, diazepam, valium, acetaminophen, ibuprofen, multivitamin |
Shaw et al. 2021 [50] | NR | Patient-controlled analgesia morphine (0.02 mg/kg), oral hydrocodone and acetaminophen (5-10 mg/325 mg) every 4 h, ketorolac (0.5 mg/kg) every 6 h, 300 mg gabapentin (up to 3 times a day), diazepam (2 mg) every 4 h | NR | NR | NR | NR | NR | NR |
Smith et al. 2019 [51] | Day 1 (early physical therapy and mobilization) | Non-opioid regimen for 7 days (celecoxib 200 mg every 12 h, gabapentin 300 mg every 8 h, acetaminophen 975 mg every 6 h) | NR | Diet, stool softeners, laxatives | Early catheter removal | NR | NR | Visit (2 weeks), follow-up |
Soffin et al. 2019b [52] | Within 2 h | Opioid-sparing multimodal analgesia (acetaminophen, NSAIDs, gabapentin, tramadol) | NR | Early nutrition | NR | NR | IV fluid administration cessation | Short course of tramadol |
Soffin et al. 2019a [53] | Within 2 h | Opioid-sparing multimodal analgesia (acetaminophen 1000 mg every 6 h, NSAIDs or nonpharmacological intervention with pain score < 5, meloxicam 7.5 mg every 12 h, oral tramadol 50 mg × 2 doses as needed with p’ain score ≥ 5, oxycodone 5 mg evary 3 h as needed with pain score ≥ 8) | NR | Early oral intake | NR | NR | NR | Follow-up plan |
Soffin et al. 2019c [54] | Within 90 min | Non-opioid analgesics (acetaminophen, ketorolac, gabapentin, ice, position changes if pain ≤4, 2 50-mg doses tramadol if pain 5–7, 5-mg oxycodone if pain 8–10) | NR | Early feeding | NR | NR | NR | NR |
Soffin et al. 2020 [55] | Within 2 h, physical therapy (twice daily) | Oral opioids (50-100 mg tramadol or 5-10 mg oxycodone), patient-controlled analgesia (0.2 mg·ml-1 hydromorphone IV every 10 min, 1000 mg IV and oral acetaminophen every 6 h), opioid-sparing multimodal analgesia (15-30 mg ketorolac every 8 h, 300 mg gabapentin every 8 h, 45 mg dextromethorphan every 8 h) | Pneumatic compression devices | Early oral intake (fluid and solid), bowel regimen (constipation and ileus prevention) | NR | NR | NR | NR |
Staartjes et al. 2019 [56] | 2 h after surgery, physical therapy | Opioid-sparing analgesia (NSAIDs, paracetamol, patient-controlled analgesia w/short-acting opioids) | Low-molecular-weight heparin | Day 0 (early solids and fluids intake) | Early drains and catheters removal | NR | NR | Telephone call (2–14 days after surgery), clinical and radiological follow-up (6 weeks) |
Venkata et al. 2018 [57] | Day 1 | Multimodal analgesia | NR | NR | NR | NR | NR | NR |
Wang et al. 2017 [58] | Day 0 or 1 | Analgesia (gabapentin, tramadol, acetaminophen) | Stockings and intermittent pneumatic compression | Oral nutrition | NR | NR | NR | Day 1 (audit, radiographs) |
Wang et al. 2020 [59] | Yes | Multimodal analgesia | Yes (stockings) | Early oral feeding, gastrointestinal management | Early catheter removal | NR | NR | NR |
Yang et al. 2020a [60] | Day 1 | Patient-controlled analgesia (discontinued at day 1), oral pain medication (oxycodone, valium, neurontin for 5 days, Tylenol, toradol) | NR | High fiber diet (day 1) | NR | NR | NR | Day 2–5, visit (2 weeks after) |
Yang et al. 2020b [61] | Rehabilitation | NSAID intramuscularly, IV or orally, tramadol if necessary | Intermittent pneumatic compression within several h following the end of operation, compression stocking for 1 week, muscle contraction exercise in the bed | Diet recovery (liquid diet < 200 mL 2 h after surgery, eating and drinking day 1) | Day 1 (drains and catheters) | Infection prevention (second-generation cephalosporins prophylactic use restricted within 24 h after the end of surgery, and advanced broad-spectrum antibiotics if necessary) | NR | NR |
Yang et al. 2021 [62] | Day 1–2 | Multimodal analgesia (local subcutaneous anesthetics before closure with 0.75% ropivacaine 10 mL + 0.9% saline 10 mL, patient-controlled analgesia with sufentanil 100 mg + butorphanol 8 mg + 0.9% saline, IV parecoxib 40 mg day 1, oral analgesics day 2, celecoxib capsule 200 mg or etoricoxib tablets 120 mg, once daily, with eperisone hydrochloride tablets 50 mg, 3 times daily) | NR | Early oral intake (clear liquid after 2 h, soft diet 4-6 h, normal diet day 2) | Within 24 h (subcutaneous drainage, < 50 mL daily) | NR | NR | NR |
Young et al. 2021 [63] | Within 12 h | Multimodal analgesia (acetaminophen and gabapentin, celecoxib in nonfusion cases), opioids | Subcutaneous heparin injections (anticoagulation) | Bowel regimen, regular diet | Day 1 (catheter) | Yes | NR | NR |
Band et al. 2022 [64] | Yes | Baclofen 10 mg orally 3 times daily as needed, gabapentin 300 mg every night at bedtime, and acetaminophen 650 mg every 4-6 h as needed | NR | NR | Day 1 (drain), day 0 (catheter) | NR | NR | Gabapentin, baclofen, acetaminophen, and opioids only if necessary |
Chen et al. 2022 [65] | Yes | Multimode analgesia (IV ketoprofen acid, oral celecoxib, and im dezocine 5 mg if necessary) | Low-molecular-weight heparin calcium, intermittent pneumatic compression | Oral feeding | Day 1 (drain), day 1–2 (catheter) | NR | NR | Satisfaction survey, multiple daily visits |
Leng et al. 2022 [66] | Day 1 | Opioid sparing, IV parecoxib 40 mg, celecoxib 200 mg and pregabalin 75 mg every 12 h, tramadol 100 mg if necessary | NR | Oral diet, clear liquids (day 0) | Day 1 (catheter), day 2 (drain) | NR | NR | Mobile app, NRS, NDI and JOA scores |
Porche et al. b2022 [67] | Day 0–1 | Multimodal analgesia (IV acetaminophen, duloxetine or gabapentin, methadone), narcotics, no valium and NSAIDs, baclofen or cyclobenzaprine for spasms | Subcutaneous heparin (5000 − 7500 U/kg, day 0), lower extremity pneumatic pumps, on-bed movement, and early off-bed mobilization | Diet ordered and protein supplements (day 0), scheduled polyethylene glycol, docusate, and senna | Day 0 (catheter), day 1 (drain) | NR | IV fluids discontinuation (day 1) | NR |
Porche et al. a2022 [68] | Day 0–1 | Multimodal analgesia (IV acetaminophen, duloxetine or gabapentin, methadone), narcotics, no valium and NSAIDs, baclofen or cyclobenzaprine for spasms | Subcutaneous heparin (5000 − 7500 U/kg, day 0), lower extremity pneumatic pumps, on-bed movement, and early off-bed mobilization | Diet ordered and protein supplements (day 0), scheduled polyethylene glycol, docusate, and senna | Day 0 (catheter), day 1 (drain) | NR | IV fluids discontinuation (day 1) | NR |
Sun et al. 2022 [69] | Yes (functional exercise) | NR | NR | Diet | NR | NR | NR | Follow-up phone call (VAS, BI and ODI scores) |
Wang et al. 2022 [70] | Physical therapy within 2 h, ambulating within 48 h | Multimodal analgesia | NR | Early drinking water, early feeding 6 h after | Catheter (after 24 h) | NR | NR | NR |
Zhang et al. 2022 [71] | Yes (4, 8 and 24 h after) | Analgesia (parecoxib sodium and morphine, oral etoricoxib) | Physical cold and adjustable negative pressure suction | Oral diet (day 2) | NR | NR | NR | NR |