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 .
Efficacy of intravenous ketoprofen for pre-emptive analgesia.
AIM To determine whether intravenous ketoprofen is effective as pre-emptive analgesia for breast surgery . DESIGN R and omised , controlled , double blind study . PATIENTS AND METHODS 50 patients undergoing breast surgery under general anaesthesia r and omised to receive either 100 mg intravenous ketoprofen 30 minutes before ( Group I ) , or immediately after surgical incision ( Group II ) . Postoperatively , pain scores ( Visual Analogue Scale , VAS ) and time to rescue analgesic were recorded by an independent , blinded observer . The study was terminated when rescue analgesic was required ( VAS > or = 4 or dem and for analgesic ) . STATISTICAL ANALYSIS Continuous variables were analysed by the unpaired ' t ' test , discrete variables with the chi square test , and survival curves by the log-rank test . RESULTS Pain scores were significantly lower in Group I till 10 hours after surgery . The number of patients requiring analgesia at 4 , 6 , 8 and 10 hours was significantly lower in group I ( 0 % vs. 47 % [ P < 0.0001 ] , 0 % vs. 44 % [ P < 0.003 ] , 0 % vs. 80 % [ P < 0.0001 ] , 0 % vs. 100 % [ P < 0.0001 ] respectively ) . The mean time for rescue analgesic was 15.47 -/+ 2.87 hours in group I versus 4.22 -/+ 2.55 hours in group II ( P < 0.0001 ) . CONCLUSION Pre-emptive analgesia with Intravenous ketoprofen ( 100 mg ) produces better postoperative pain-relief in patients undergoing breast 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 .