Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .
A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast
Summary Background In this prospect i ve , r and omized , placebo-controlled , double-blinded clinical trial we tested the hypothesis that preemptive analgesia with bupivacaine applied in the area of the surgical incision in patients undergoing mastectomy for breast cancer would reduce post-operative acute pain and would reduce the amount of analgesics used during surgery and in the post-operative period . Material / Methods Participants were assigned into 1 of 2 groups – with bupivacaine applied in the area of surgical incision or with placebo . We assessed the intraoperative consumption of fentanyl , the postoperative consumption of morphine delivered using a PCA method , and the subjective pain intensity according to VAS score reported by patients in the early post-operative period . Results Out of 121 consecutive cases qualified for mastectomy , 112 women were allocated r and omly to 1 of 2 groups – group A ( bupivacaine ) and group B ( placebo ) . The final study group comprised 106 breast cancer cases . Between the groups , a statistically significant difference was observed with respect to : lower fentanyl consumption during surgery ( p=0.011 ) , lower morphine ( delivered by means of a PCA ) consumption between the 4–12th postoperative hours ( p=0.02 ) and significantly lower pain intensity assessed according to VAS score at the 4th and 12th hours after surgery ( p=0.004 and p=0.02 respectively ) for the group A patients . Conclusions Preemptive analgesia application in the form of infiltration of the area of planned surgical incisions with bupivacaine in breast cancer patients undergoing mastectomy decreases post-operative pain sensation , limits the amount of fentanyl used during surgery , and reduces the dem and for opiates in the hours soon after surgery
Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .