POSTOPERATIVE STRATEGIES Prevention of nausea and vomiting – Nausea and vomiting after surgery is a common occurrence and may result in dehydration and inadequate nutritional intake leading to a prolonged hospital stay. Female patients, those with a history of nausea/vomiting or motion sickness and non-smokers are at increased risk. Thus, patients with risk factors should ideally be treated prophylactically during surgery with antiemetics (drugs used to prevent or treat nausea/vomiting). Pain management – Adequate pain control is essential to enhanced recovery after surgery. In general , techniques that avoid or use less opioid drugs result in getting out of bed sooner, faster return of bowel function, fewer complications, and reduced length of stay. Using a combination of drugs (multimodal approach) that rely on several pain reducing mechanisms along with regional anesthesia techniques (spinal/epidural or nerve blocks, when possible) is optimal. Early mobilization – Prolonged bed rest is associated with greater lung complications, blood clots, higher blood sugars, and decreased muscle strength. Early mobilization is therefore an important component of improving the recovery process. However, just like exercise in the preoperative period, getting out of bed and exercising some as soon as possible after surgery does increase functional capacity but the evidence that it improves outcomes remains mixed with some studies showing benefit but others that showing no change. Nutritional care – Delays in restarting a normal diet by mouth is known to increase infectious complications and prolong the recovery period. Thus, many (but not all) patients should receive food by mouth from the day of surgery. Even when they are able to eat, the postoperative period is often characterized by lowered overall oral intake. Furthermore, during this recovery period, there is greater breakdown of muscle protein in order to increase the availability of glucose to meet energy needs. Thus, additional oral nutritional supplements are often needed. [8]
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