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 single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: randomized placebo-controlled double-blind trial.
BACKGROUND Gabapentin has been recently found to be useful for reducing acute postoperative pain when administered preoperatively . Although various dose regimens have been tried in different surgical setting s , the minimum effective dose is not established . AIMS We aim ed to evaluate the analgesic efficacy of single low dose gabapentin in patients undergoing total mastectomy and axillary dissection . SETTING S AND DESIGN Prospect i ve r and omized placebo-controlled double-blind trial in a tertiary care teaching hospital . MATERIAL S AND METHODS Fifty women scheduled for total mastectomy and axillary dissection were r and omized to receive either gabapentin 600 mg or placebo orally 1 h preoperatively . The intraoperative and postoperative management was st and ardized . Postoperative pain was assessed at rest and on movement for 12 h using the numerical rating scale ( NRS ) .  Morphine  was administered if NRS exceeded 30 . Primary outcome measure was total morphine consumption . STATISTICAL ANALYSIS The morphine consumption was compared using independent t test while pain and sedation scores were analyzed using Mann-Whitney U test . RESULTS Forty-six patients completed the trial . The postoperative morphine consumption was significantly less ( 5.8 + /- 4.2 vs. 11.0 + /- 3.4 mg ; P 0.001 ) and the median [ IQR ] time to first analgesic was significantly longer ( 90 [ 37.5 - 120 ] vs. 0 [ 0 - 90 ] min ; P 0.001 ) in the gabapentin group than in the placebo group . The incidence of side effects was similar in the two groups . CONCLUSIONS A single low dose of 600 mg gabapentin administered 1 h prior to surgery produced effective and significant postoperative analgesia after total mastectomy and axillary dissection without significant side effects
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 .