Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .
Preemptive Analgesia by Intravenous Low-dose Ketamine and Epidural Morphine in Gastrectomy: A Randomized Double-blind Study
Background Morphine and ketamine may prevent central sensitization during surgery and result in preemptive analgesia . The reliability of preemptive analgesia , however , is controversial . Methods Gastrectomy patients were given preemptive analgesia consisting of epidural morphine , intravenous low-dose ketamine , and combinations of these in a r and omized , double-blind manner . Postsurgical pain intensity was rated by a visual analog scale , a categoric pain evaluation , and cumulative morphine consumption . Results Preemptive analgesia by epidural morphine and by intravenous low-dose ketamine were significantly effective but not definitive . With epidural morphine , a significant reduction in visual analog scale scores at rest was observed at 24 and 48 h , and morphine consumption was significantly lower at 6 and 12 h , compared with control values . With intravenous ketamine , visual analog scale scores at rest and morphine consumption were significantly lower at 6 , 12 , 24 , and 48 h than those in control subjects . The combination of epidural morphine and intravenous ketamine provided definitive preemptive analgesia : Visual analog scale scores at rest and morphine consumption were significantly the lowest at 6 , 12 , 24 , and 48 h , and the visual analog scale score during movement and the categoric pain score also were significantly the lowest among the groups . Conclusion The results suggest that for definitive preemptive analgesia , blockade of opioid and N-methyl-d-aspartate receptors is necessary for upper abdominal surgery such as gastrectomy ; singly , either treatment provided significant , but not definitive , postsurgical pain relief . Epidural morphine may affect the spinal cord segmentally , whereas intravenous ketamine may block brain stem sensitization via the vagus nerve during upper abdominal surgery
Overall , there is little direct evidence for components of ERAS , with much derived from nonesophageal thoracoabdominal surgery .
ERAS in principle seems logical and safe for esophagectomy .
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery ( ERAS ) programs for  esophagectomy  and generate guidelines .
BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery .
Although ERAS is well established in colorectal surgery , experience after esophagectomy has been minimal .
However , esophagectomy remains an extremely high-risk operation , commonly performed in patients with significant comorbidities .
Consequently , ERAS may have a significant role to play in improving outcomes .
No guidelines or review s have been published in esophagectomy .