**4. ERAS protocol in orthopedic surgery**

The ERAS Protocol (Enhanced Recovery After Surgery), is a multidisciplinary approach designed for the patient's recovery after surgery. This approach has been used widely in orthopedic surgery for the reduction in the intrahospital stay, postoperative pain, and opioid needs [15].

#### **4.1 Components of enhanced recovery after surgery in orthopedic surgery**

Preoperative interventions include patient's education about the recuperation process, nutrition and hydration, as well as respiratory and cardiovascular optimization. Intraoperative interventions include use of regional and multimodal anesthesia to reduce the necessity of opioids. Postoperative interventions include early mobilization, multimodal pain management and early hospital discharge [16].

The principal postoperative undesirable sequelae include pain, cardiopulmonary, infectious and thromboembolic complications, cerebral dysfunction, gastrointestinal paralysis, nausea, and prolonged hospital stay. Surgical and anesthetic techniques are related to the presence or severity in which the adverse effects can be present. On the other hand, one must consider changes related to organic function, which are present in every patient that goes through a surgical procedure, commonly known as surgical stress.

It has been proven that ERAS Protocol effectively reduces the length in intrahospital stay, postoperative pain and opioid need. It has also been demonstrated that the ERAS Protocol positively affects cardiopulmonary function, quality of life and patient's satisfaction [17]. However, implementation of the ERAS (**Tables 1** and **2**) Protocol in an orthopedic surgery can be quite challenging, as it requires an adequate collaboration between surgeons, anesthesiologists, nurses, and other healthcare specialists. Also, the ERAS Protocol implementation can require an expensive investment in resource and capacitation time.


**Table 1.** *ERAS in orthopedic surgery.*

#### *Postoperative Pain in Orthopedics*

*DOI: http://dx.doi.org/10.5772/intechopen.111880*


#### **Table 2.** *ERAS protocol implementation.*
