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 .
Systemic magnesium to improve quality of post-surgical recovery in outpatient segmental mastectomy: a randomized, double-blind, placebo-controlled trial.
BACKGROUND It remains to be determined if perioperative systemic magnesium can improve postoperative quality of recovery of patients undergoing ambulatory procedures . The main objective of the current investigation was to evaluate the effect of systemic magnesium on postoperative quality of recovery in patients undergoing outpatient segmental mastectomies . METHODS The study was a prospect i ve r and omized , double-blind , placebo-controlled , clinical trial . Female subjects were r and omized to receive intravenous magnesium ( MgSO4 50mg/kg in 100 mL of normal saline over 15 min before anesthesia induction , followed by an infusion of 15 mg/kg/hour ) or the same volume of saline . The primary outcome was the Quality of Recovery 40 ( QOR-40 ) question naire at 24 hours after surgery . RESULTS 50 subjects were recruited and 46 completed the study . Patients in the magnesium group had better global Quality of Recovery scores compared with the saline group , with a median difference of 24 ( 99 % CI , 3 to 33 ) , P<0.001 . After discharge from hospital , subjects in the magnesium group required less oral opioids , median ( IQR ) of 10 ( 0 to 20 ) ( oral milligrams of morphine equivalents ) than the saline group , 30 ( 20 to 40 ) ( P<0.001 ) . The postoperative systemic magnesium concentrations were substantially higher in the magnesium group , 1.25 ± 0.28 mmol/L compared to control , 0.71 ± 0.11 mmol/L , P<0.0001 . Simple linear regression demonstrated a direct linear relationship between the postoperative systemic magnesium concentrations and 24 hour postoperative quality of recovery scores ( P = 0.004 ) , and also an inverse relationship with pain burden in the postoperative care unit ( P = 0.01 ) . CONCLUSIONS Systemic magnesium improves postoperative quality of recovery in patients undergoing outpatient segmental mastectomy .  Systemic magnesium is a safe , inexpensive , efficacious strategy to improve quality of recovery after ambulatory surgery
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 .