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 small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy.
UNLABELLED We evaluated the preemptive analgesic effect of a small dose of ketamine given before or immediately after surgery in a r and omized , double-blinded study performed in 128 women undergoing total mastectomy . Group 1 patients received ketamine 0.15 mg/kg as a 5-mL i.v . injection 5 min before surgery and isotonic saline 5 mL i.v . at the time of skin closure . Group 2 received 5 mL i.v . of isotonic saline , then 0.15 mg/kg i.v . ketamine . A st and ard general anesthesia procedure including sufentanil was used . In the recovery room , patient-controlled analgesia i.v . morphine was used for postoperative analgesia . Postoperative pain was assessed by measuring morphine consumption and visual analog scale pain scores . No significant intergroup differences were seen in the pain scores . Patient-controlled analgesia morphine consumption was lower during the first 2 h after surgery in patients given ketamine at the time of skin closure . No patient complained of hallucinations or nightmares . The incidence of adverse effects was not different between the two groups . In conclusion , administering ketamine at the end of surgery is more effective in reducing morphine consumption than it is when given before surgery . IMPLICATION S We administered the same small dose of ketamine before or after surgery . The preoperative administration of 0.15 mg/kg ketamine in patients undergoing total mastectomy did not elicit a preemptive analgesic effect . Ketamine given at closure reduced the patient-controlled analgesia morphine requirement in the first 2 h after 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 .