OBJECTIVE: To summarize research progress on enhanced recovery after posterior cruciate ligament (PCL) reconstruction, clarify the core contradictions, effective intervention methods, and evaluation shortcomings in current clinical practice, and provide theoretical support for optimizing clinical rehabilitation strategies. METHODS: Relevant domestic and international literature in recent years was systematically searched. The key technologies and challenges for enhanced recovery after PCL reconstruction were analyzed from three aspects: the core issues of enhanced recovery after PCL reconstruction, treatment strategies, and the post-reconstruction effectiveness evaluation system. RESULTS: Enhanced recovery after PCL reconstruction mainly faces two core problems. First, there is a balance dilemma between graft tendon protection and knee joint function recovery: the tensile capacity of the graft tendon is weak in the early postoperative period, so excessive weight-bearing easily leads to relaxation, while overly conservative immobilization causes muscle atrophy and joint adhesion. Second, the return-to-sport rate is significantly affected by injury type and treatment method: patients with combined multiple ligament or meniscus injuries have a much lower return-to-sport rate than those with isolated PCL injury, and the risk of return-to-sport failure is higher. Current research mainly promotes rehabilitation from two aspects: physical therapy and surgical technology. Physical therapy runs through the perioperative period: preoperatively, muscle strength training, swelling control, and maintenance of joint range of motion are used to optimize surgical conditions; postoperatively, phased intervention is implemented. Surgical technology focuses on minimally invasive and anatomical approaches: arthroscopic surgery reduces injury, double-bundle reconstruction and internal tension-relief technology improve stability, and modified tunnel positioning and special surgical methods avoid the risk of "Killer Turn". Postoperative functional evaluation adopts multi-dimensional indicators: subjective evaluation relies on scales such as Lysholm and International Knee Documentation Committee (IKDC); objective evaluation assesses stability through Telos stress test and posterior drawer test; imaging evaluation takes MRI as the core; psychological evaluation is assisted by the Tampa scale of kinesiophobia-11 (TSK-11). However, there are obvious shortcomings, such as the lack of PCL-specific evaluation tools. CONCLUSION Enhanced recovery after PCL reconstruction requires the integration of precise surgery, individualized rehabilitation, and comprehensive subjective and objective evaluation. In the future, biomaterials and digital technologies should be integrated to optimize the full-cycle management of PCL reconstruction, thereby improving functional recovery and the effect of return to sports.
Humans ; Posterior Cruciate Ligament Reconstruction/rehabilitation* ; Posterior Cruciate Ligament/injuries* ; Recovery of Function ; Knee Joint/physiopathology* ; Knee Injuries/rehabilitation* ; Return to Sport ; Enhanced Recovery After Surgery ; Tendons/transplantation* ; Arthroscopy

The implementation of enhanced recovery after surgery (ERAS) protocols has led to increased interest in nonintubated video-assisted thoracoscopic surgery (NIVATS), especially in patients with compromised pulmonary function. We present a case of a 62-year-old female with stage IIIA breast cancer and pulmonary bronchiectasis who underwent right-sided wedge resection via NIVATS. A two-level thoracic paravertebral block (TPVB) at T4 and T6 using 0.4% isobaric bupivacaine with epinephrine was performed, resulting in sensory block from T2 to T7. An intrathoracic vagal block with 0.5% bupivacaine was administered to prevent cough. Sedation was maintained with dexmedetomidine and remifentanil. Surgery lasted 83 minutes with no complications. Postoperatively, pain was minimal (NRS 0–2), the patient mobilized within 6 hours and was discharged the next day. This case highlights the feasibility and safety of TPVB-based NIVATS in a high-risk patient, aligning with ERAS goals of enabling early recovery, avoiding airway instrumentation and minimizing opioid use.

The implementation of enhanced recovery after surgery (ERAS) protocols has led to increased interest in nonintubated video-assisted thoracoscopic surgery (NIVATS), especially in patients with compromised pulmonary function. We present a case of a 62-year-old female with stage IIIA breast cancer and pulmonary bronchiectasis who underwent right-sided wedge resection via NIVATS. A two-level thoracic paravertebral block (TPVB) at T4 and T6 using 0.4% isobaric bupivacaine with epinephrine was performed, resulting in sensory block from T2 to T7. An intrathoracic vagal block with 0.5% bupivacaine was administered to prevent cough. Sedation was maintained with dexmedetomidine and remifentanil. Surgery lasted 83 minutes with no complications. Postoperatively, pain was minimal (NRS 0–2), the patient mobilized within 6 hours and was discharged the next day. This case highlights the feasibility and safety of TPVB-based NIVATS in a high-risk patient, aligning with ERAS goals of enabling early recovery, avoiding airway instrumentation and minimizing opioid use.

The implementation of enhanced recovery after surgery (ERAS) protocols has led to increased interest in nonintubated video-assisted thoracoscopic surgery (NIVATS), especially in patients with compromised pulmonary function. We present a case of a 62-year-old female with stage IIIA breast cancer and pulmonary bronchiectasis who underwent right-sided wedge resection via NIVATS. A two-level thoracic paravertebral block (TPVB) at T4 and T6 using 0.4% isobaric bupivacaine with epinephrine was performed, resulting in sensory block from T2 to T7. An intrathoracic vagal block with 0.5% bupivacaine was administered to prevent cough. Sedation was maintained with dexmedetomidine and remifentanil. Surgery lasted 83 minutes with no complications. Postoperatively, pain was minimal (NRS 0–2), the patient mobilized within 6 hours and was discharged the next day. This case highlights the feasibility and safety of TPVB-based NIVATS in a high-risk patient, aligning with ERAS goals of enabling early recovery, avoiding airway instrumentation and minimizing opioid use.

OBJECTIVE

Enhanced Recovery After Surgery (ERAS) represents an evidenced-based approach to surgical management challenging traditional paradigms with the goal of maintaining normal physiology perioperatively, hence, these benefits were replicated across the spectrum of gynecologic surgeries. The study aims to determine if there is a significant difference in patient's outcome between ERAS and standard diet who will undergo elective abdominal hysterectomies with or without salpingo oophorectomy for benign gynecologic lesions.

This study is a single blind, superiority, randomized controlled trial design. Participants were group as ERAS and standard diet. A total of 15 cases in each study arm was judged sufficient to ensure confidence interval of 95%, 80% power (beta error), 5% margin of error, 50 % of exposed with outcome and 0.5% percent of unexposed with outcome generated from OpenEpi Version 3.01. It utilized descriptive and inferential analysis. Comparative analysis was done using Z-test of proportion for categorical variables and MannWhitney test for continuous variable. Two tailed with values of P < 0.05 were concluded statistically significant.

Between January 2021 to December 2021, there were 30 cases participated in this study. ERAS shown better result such as shorter length of hospital stay (pCONCLUSION

The study showed better patient's outcome, postoperative complications and subjective well-being who underwent elective abdominal hysterectomies with or without salpingo-oophorectomy for benign gynecologic lesions under ERAS. Our findings may contribute in the standardization of guidelines for perioperative nutritional care in elective abdominal hysterectomies with or without salpingooophorectomy for benign gynecologic conditions.

Aged ; Female ; Humans ; Middle Aged ; China ; Consensus ; East Asian People ; Enhanced Recovery After Surgery ; Gynecologic Surgical Procedures/methods* ; Length of Stay ; Pelvic Floor/surgery* ; Perioperative Care/methods* ; Plastic Surgery Procedures/methods* ; Postoperative Complications/prevention & control* ; Quality of Life ; Recovery of Function

Enhanced recovery after surgery (ERAS) measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia (BPH). This study was performed on patients with BPH who required surgical intervention. From July 2019 to June 2020, the ERAS program was applied to 248 patients, and the conventional program was applied to 238 patients. After 1 year of follow-up, the differences between the ERAS group and the conventional group were evaluated. The ERAS group had a shorter time of urinary catheterization compared with the conventional group (mean ± standard deviation [s.d.]: 1.0 ± 0.4 days vs 2.7 ± 0.8 days, P < 0.01), and the pain (mean ± s.d.) was significantly reduced through postoperative hospitalization days (PODs) 0-2 (POD 0: 1.7 ± 0.8 vs 2.4 ± 1.0, P < 0.01; POD 1: 1.6 ± 0.9 vs 3.5 ± 1.3, P < 0.01; POD 2: 1.2 ± 0.7 vs 3.0 ± 1.3, P < 0.01). No statistically significant difference was found in the rate of postoperative complications, such as postoperative bleeding (P = 0.79), urinary retention (P = 0.40), fever (P = 0.55), and readmission (P = 0.71). The hospitalization cost of the ERAS group was similar to that of the conventional group (mean ± s.d.: 16 927.8 ± 5808.1 Chinese Yuan [CNY] vs 17 044.1 ± 5830.7 CNY, P =0.85). The International Prostate Symptom Scores (IPSS) and quality of life (QoL) scores in the two groups were also similar when compared at 1 month, 3 months, 6 months, and 12 months after discharge. The ERAS program we conducted was safe, repeatable, and efficient. In conclusion, patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.
Male ; Humans ; Prostatic Hyperplasia/complications* ; Quality of Life ; Transurethral Resection of Prostate/adverse effects* ; Treatment Outcome ; Enhanced Recovery After Surgery

OBJECTIVE: To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity. METHODS: Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups ( P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation ( P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient's satisfaction were recorded. RESULTS: The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group ( P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points ( P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation ( P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points ( P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group ( P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence ( P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups ( P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant ( P>0.05). CONCLUSION For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
Humans ; Arthroplasty, Replacement, Hip ; Enhanced Recovery After Surgery ; Comorbidity ; Pain ; Postoperative Period

Humans ; Enhanced Recovery After Surgery ; Stomach Neoplasms/surgery* ; Length of Stay ; Laparoscopy ; Postoperative Complications ; Gastrectomy

This paper reviews the researches on acupuncture preconditioning before surgery in recent years and explores its application value from three aspects, i.e. relieving preoperative anxiety, preventing from postoperative cognitive dysfunction, and preventing from postoperative gastrointestinal dysfunction. As a relatively safe non-drug treatment, acupuncture has the underlying advantages in participating into multidisciplinary coordination in the enhanced recovery after surgery (ERAS). By building up higher-quality medical evidences and revealing the effect mechanism of acupuncture from multi-dimenisonal aspects, it is expected that acupuncture technology can be coordinated with ERAS to optimize the clinical path in the perioperative period, and boost the development of the perioperative medicine ultimately.
Humans ; Acupuncture Therapy ; Anxiety ; Anxiety Disorders ; Enhanced Recovery After Surgery ; Perioperative Period