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 .
A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy.
BACKGROUND The anticonvulsant gabapentin has proven effective for neuropathic pain in three large placebo-controlled clinical trials . Experimental and clinical studies have demonstrated antihyperalgesic effects in models involving central neuronal sensitization . It has been suggested that central neuronal sensitization may play an important role in postoperative pain . The aim of the study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in patients undergoing radical mastectomy . METHODS In a r and omized , double-blind , placebo-controlled study , 70 patients received a single dose of oral gabapentin ( 1,200 mg ) or placebo 1 h before surgery . Patients received patient-controlled analgesia with morphine at doses of 2.5 mg with a lock-out time of 10 min for 4 h postoperatively . Pain was assessed on a visual analog scale at rest and during movement , and side effects were assessed on a four-point verbal scale 2 and 4 h postoperatively . RESULTS Thirty-one patients in the gabapentin group and 34 patients in the placebo group completed the study . Gabapentin reduced total morphine consumption from a median of 29 ( interquartile range , 21 - 33 ) to 15 ( 10 - 19 ) mg ( P < 0.0001 ) . Pain during movement was reduced from 41 ( 31 - 59 ) to 22 ( 10 - 38 ) mm at 2 h postoperatively ( P < 0.0001 ) and from 31 ( 12 - 40 ) to 9 ( 3 - 34 ) mm at 4 h postoperatively ( P = 0.018 ) . No significant differences between groups were observed with regard to pain at rest or side effects . CONCLUSION A single dose of 1,200 mg oral gabapentin result ed in a substantial reduction in postoperative morphine consumption and movement-related pain after radical mastectomy , without significant side effects . These promising results should be vali date d in other acute pain models involving central neuronal sensitization
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 .