A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Postoperative Nausea and Vomiting Are Strongly Influenced by Postoperative Opioid Use in a Dose-Related Manner
We prospect ively examined the incidence of postoperative nausea and vomiting ( PONV ) in a group of 193 elderly surgical in patients receiving no postoperative antiemetic prophylaxis .  Risk factors for PONV and detailed data on postoperative opioid use were recorded . The overall postoperative vomiting ( POV ) rate was 23.8 % , whereas postoperative nausea ( PON ) was 51.3 % . Opioid use ( P = 0.025 ) , and female gender ( P = 0.038 ) were identified as significantly influencing POV in this relatively small population . There was a strong logarithmic dose-response relationship between postoperative opioid dose and POV ( r2 = 0.98 , P < 0.01 ) , as well as PON ( r2 = 0.98 , P = 0.01 ) . Use of patient-controlled analgesia or epidural analgesia was a marker for large-dose opioid use ( P < 0.001 ) and was associated with POV in the 24-h postoperative period of 41 % and 31 % respectively , compared with 11 % for other patients ( P < 0.001 ) . Future studies defining risk factors for POV should treat postoperative opioid use as a continuous variable , rather than treat it as a dichotomous variable
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .