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 .
Postoperative nausea and vomiting prophylaxis: A comparative study of ondansetron, granisetron and granisetron and dexamethasone combination after modified radical mastectomy
Background : Post-operative nausea and vomiting ( PONV ) is commonly seen after modified radical mastectomy ( MRM ) . In this r and omized double-blind prospect i ve study we compared the efficacy of ondansetron , granisetron and granisetron and dexamethasone combination for prevention of PONV following MRM in female patients . Material s and Methods : A total of 75 patients ( 20 - 60 years of age ) undergoing elective MRM were r and omly allocated to one of the three groups of 25 patients each . Group O received ondansetron 4 mg , Group G received granisetron 40 mcg/kg and group granisetron and dexamethasone ( G + D ) received granisetron 40 mcg/kg + dexamethasone 8 mg prior to induction . All episodes of PONV within 24 h after induction of anesthesia were recorded . Statistical Analysis : Statistical analysis was done using Kruskal-Wallis test ( nonparametric ANOVA ) . Results : The incidence of complete response ( no PONV , no rescue medication ) was 96 % with G+D , as compared with 86 % with granisetron and 4 % with ondansetron during 0 - 3h after surgery which was clinical ly significant ( P < 0.05 ) . Similarly clinical ly significant response was seen during 3 - 6 , 6 - 9 , 9 - 12 and 12 - 24 h of surgery . Conclusion : Granisetron and dexamethasone combination is more effective for prevention of PONV in comparison to individual ondansetron and granisetron in MRM
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 .