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 .
Aprepitant plus Ondansetron Compared with Ondansetron Alone in Reducing Postoperative Nausea and Vomiting in Ambulatory Patients Undergoing Plastic Surgery
Background : Postoperative nausea and vomiting is a major challenge in the perioperative setting . The incidence can be as high as 80 percent , and the majority of the symptoms among out patients occur after discharge . This study evaluated the efficacy of a neurokinin-1 receptor antagonist ( aprepitant ) in reducing postoperative symptoms for up to 48 hours in patients undergoing outpatient plastic surgery . Methods : A prospect i ve , double-blinded , r and omized , two-arm evaluation of 150 ambulatory plastic surgery patients receiving a st and ardized general anesthetic , including postoperative nausea and vomiting prophylaxis with ondansetron and either aprepitant or placebo  , was performed . The main outcome measures were the occurrence of vomiting and the severity of nausea for up to 48 hours postoperatively . Results : Overall , 9.3 percent of patients who received aprepitant versus 29.7 percent in group B had vomiting , with the majority of vomiting episodes occurring after hospital discharge . The Kaplan-Meier plot of the hazards of vomiting revealed an increased incidence of emesis in patients receiving ondansetron alone compared with the combination of ondansetron and aprepitant ( p = 0.006 ) . The incidence of nausea was not significantly different in the two groups . Severity of nausea , however , was significantly higher in those receiving ondansetron alone compared with those receiving ondansetron and aprepitant , as measured by a peak nausea score ( p = 0.014 ) and by multivariate analysis of variance results comparing repeated verbal rating scale scores over 48 hours after surgery ( p = 0.024 ) . Conclusion : In patients undergoing plastic surgery , the addition of aprepitant to ondansetron significantly decreases postoperative vomiting rates and nausea severity for up to 48 hours postoperatively . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , II
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 .