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 .
Does perioperative administration of rofecoxib improve analgesia after spine, breast and orthopaedic surgery?
Background and objective : Data on the effectiveness of cyclooxygenase 2 inhibitors in postoperative pain therapy vary widely . We tested in a prospect i ve , placebo‐controlled , r and omized , double‐blind trial the hypotheses that perioperative ( i.e. preoperative and postoperative ) administration of the cyclooxygenase 2 inhibitor rofecoxib decreases pain scores and morphine consumption after spine , breast and orthopaedic surgery . Methods : Five hundred and forty patients scheduled for spine , breast or orthopaedic surgery were r and omly assigned to receive in combination with postoperative morphine via patient controlled analgesia pump for 4 days either rofecoxib 50 mg administered perioperatively , rofecoxib 50 mg administered only postoperatively , or placebo . Primary outcome criteria were pain score at rest ( numeric rating scale 0–4 ) and morphine consumption . Results : Perioperative rofecoxib significantly decreased pain score 0 ( 0–1 ) vs. 1 ( 0–2 ) ( median ( interquartile range ) ) , and morphine consumption 18 ( 6–33 ) vs. 22.5 ( 12–38 ) compared with placebo . In contrast , rofecoxib when administered only postoperatively did not significantly improve analgesic effects or side‐effects at time of assessment of the main criteria ( 24 h after skin closure ) , but during the follow‐up period at 48 h and 72 h after skin closure pain scores and morphine consumption were improved compared to placebo . The analgesic effects of rofecoxib were independent from the type of surgery . Conclusions : Perioperative administration of the cyclooxygenase 2 inhibitor rofecoxib decreases pain scores and morphine consumption after orthopaedic , breast and spine surgery . However , the benefit of preoperative administration of the cyclooxygenase 2 inhibitor seems to be only moderate , suggesting that early postoperative administration may be a useful alternative approach . There is no evidence that the type of surgery influences analgesic effects of cyclooxygenase 2 inhibitors
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 .