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 .
Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy
Purpose The use of opioids following surgery is associated with a high incidence of postoperative nausea and vomiting ( PONV ) . We conducted a prospect i ve , r and omized , double-blind , placebo-controlled study to investigate the effect of orally administered aprepitant , a neurokinin-1 receptor antagonist , for reducing PONV in patients with fentanyl-based , patient-controlled analgesia ( PCA )  given intravenously after gynecological laparoscopy . Methods One hundred and twenty female patients ( ages 21–60 ) undergoing laparoscopic hysterectomy were r and omly allocated to receive 80 mg ( A80 group , n = 40 ) or 125 mg aprepitant ( A125 group , n = 40 ) or placebo ( control group , n = 40 ) orally 2 h before anesthesia induction . Anesthesia was maintained with isoflurane and remifentanil , and PCA IV using fentanyl and ketorolac were provided for 48 h after surgery . Incidences of nausea , vomiting/retching , and use of rescue antiemetics were recorded at 2 , 24 , and 48 h after surgery . Complete response was defined as no PONV and no need for rescue treatment . Results The incidence of complete response was significantly lower in the A80 and A125 groups than in controls , 56 % and 63 % , vs. 28 % , respectively , P = 0.007 and P = 0.003 , respectively , during the first 48 h , and 65 % and 65 % vs. 38 % , respectively , both P = 0.025 , during the first 2 h. However , there were no statistically significant differences between A80 and A125 groups in the incidences of complete response and PONV during the study period . Conclusions Aprepitant 80 mg orally was effective in lowering the incidence of PONV in the first 48 h after anesthesia in patients receiving fentanyl-based PCA  after gynecological laparoscopy
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 .