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 .
Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer
Background Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures . We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting ( PONV ) , and pain  after mastectomy . Methods In this prospect i ve , double-blind , placebo-controlled study , 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after r and omization to treatment with 8 mg intravenous dexamethasone ( n = 35 ) or placebo ( n = 35 ) . All patients underwent st and ardized procedures for general anesthesia and surgery . Episodes of PONV and pain score were recorded on a visual analogue scale . Analgesic and antiemetic requirements were also recorded . Results Demographic and medical variables were similar between groups . The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation ( 28.6 % vs. 60 % ; p = 0.02 ) and at 6 h ( 17.2 % vs. 45.8 % ; p = 0.03 ) . More patients in the placebo group required additional antiemetic medication ( 21 vs. 8 ; p = 0.01 ) . Dexamethasone treatment significantly reduced postoperative pain just after surgery ( VAS score , 4.54 ± 1.55 vs. 5.83 ± 2.00 ; p = 0.004 ) , at 6 h ( 3.03 ± 1.20 vs. 4.17 ± 1.24 ; p < 0.0005 ) and at 12 h ( 2.09 ± 0.85 vs. 2.54 ± 0.98 ; p = 0.04 ) . Analgesics were required in more patients of the control group ( 21 vs. 10 ; p = 0.008 ) . There were no adverse events , morbidity or mortality . Conclusions Preoperative intravenous dexamethasone ( 8 mg ) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer . Trial registration
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 .