It aims at speeding up functional recovery and improving postoperative outcomes. It focuses on optimizing patient education, decreasing the preoperative fasting period, early patient mobilization, providing multimodal pain relief, providing multimodal nausea and vomiting prophylaxis, and decreasing unnecessary or prolonged use of catheters and drains.
The patient is provided with some pre-procedure information which includes -Consumption of solids is allowed up to six hours prior to anesthetic induction, clear liquids up to two hours prior to anesthetic induction, and preoperative carbohydrate loading is encouraged
- Mechanical bowel preparation is not indicated for most gynecologic surgery
- For prevention of surgical site infection, patients should shower or bathe with soap and water before surgery or at least the night before the surgery
- Patients are given oral acetaminophen, gabapentin, and celecoxib preoperatively with the goal of reducing postoperative pain (table 2) [19].
- Infiltration of the surgical site with local anesthetic, the possible use of transversus abdominis plane (TAP) blocks, or the possible use of neuraxial anesthesia (spinal or thoracic epidural anesthesia) are the other potential analgesic modalities
- Catheters, drains, and NG tubes are avoided
- A minimally invasive approach is preferred for surgery and patients undergoing surgery for benign causes are expected to be discharged in 1-2 days
- Intravenous opioids are avoided for postoperative pain relief and oral acetaminophen/NSAIDs are started for breakthrough pain
- Regular diet, bowel regimen, and early ambulation are initiated on postoperative day 0
- Criteria for discharge for any patient undergoing gynecologic surgery include tolerance to a regular diet, ambulation, and pain control with oral pain medications.
- Infiltration of the surgical site with local anesthetic, the possible use of transversus abdominis plane (TAP) blocks, or the possible use of neuraxial anesthesia (spinal or thoracic epidural anesthesia) are the other potential analgesic modalities
