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 .
Strengths of early physical rehabilitation programs in surgical breast cancer patients: results of a randomized control study
BACKGROUND In the immediate postoperative period surgical breast cancer patients can face many problems including functional limitation of the shoulder , edema , pain and depression . Although those symptoms can alleviate during the stages of the therapeutic route , most of the time concur significantly to the everyday life discomforts decreasing sharply the quality of life . Therefore , is essential to pay attention to the functional problems of breast cancer patients in order to ensure a quick and complete physical and psychosocial recovery . AIM Aim of this study , comparing 2 groups of patients , one that underwent to  early physical rehabilitation program ( EPRP ) and one as a control group , is to evaluate : functional improvements of the glenohumeral joint mobility , antalgic effect of EPRP , improvements and /or worsening of quality of life . DESIGN R and omized controlled study . SETTING Inpatient and outpatient clinic , Breast Unit , " San Giuseppe Moscati " Hospital , Avellino , Italy . POPULATION Seventy women planned for Madden 's modified radical mastectomy or for segmental mastectomy with axillary dissection in the period from March 2010 to February 2011 . METHODS Patients were r and omly assigned to treated and control group . All participants were evaluated before surgery and postoperatively at fifth day , first , sixth and twelfth month . Patients of the treated group , underwent first , to assisted cautious mobilization of h and , wrist and elbow and after drainage removal , to twenty physiotherapy sessions under the guide of a physiotherapist . RESULTS Within group statistical analysis evidence d that TG regained normal function at 1 year after surgery while CG was unable to do so for flexion , abduction and internal rotation movements . TG manifested general and statistically significative improvements in QoL. Improvements in the grade of pain perceived were observed starting from the first postoperative month . CONCLUSION Postoperative early physical rehabilitation programme in surgical breast cancer patients surgically treated significantly improves glenohumeral joint mobility , reduces pain and widely improves the quality of life . CLINICAL REHABILITATION IMPACT Early rehabilitation plays a key role in the physical and psycho-social recovery for breast cancer patients surgically treated with axillary dissection
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 .