Table 1 Scheme of key elements of the VATS-specific ERAS program
Control | ERAS | |
|---|---|---|
Preoperative | ||
Consultation | No standardized information | An exhaustive preoperative patient information; psychological care |
Education | Video | Standardized education protocols; information booklet with daily goals; family member engagement; smoking cessation; nutritional advice; incentive spirometer every 1 h |
Intraoperative | ||
Pain control | Epidural catheter or intercostal; halogenated; anesthetics gases/propofol | Intercostal blocks |
Chest tube diameter | 28 F | 24 F |
Fluid control | Intravenously administration of rehydration 1800 ml | Avoidance of sodium/fluid overload; goal-directed fluid therapy |
Postoperative | ||
Analgesia | Patient controlled analgesia (dizosin) | Patient controlled analgesia (celecoxib) |
Activity | Routine | Early mobilization; out of bed 2 h on the day of surgery and 6 h per day until discharge; respiratory physiotherapy and incentive spirometer every 1 h |
Nourishment | Oral intake on the 1st day after surgery or anal exhaust | Promotion of early oral intake (water and soft foods) after surgery |
Urinary catheter | Yes | No |
Chest tube management | Water seal (passive suction); the tubes removed after less than 250 mL/24 h of drainage and no air flow | The tube removed after less than 400 mL/24 h of drainage and no air flow; detailed in Table 2 |
Discharge | Meeting discharged criteria | Meeting discharged criteria; a telephone follow-up with health education at 1 month, 3 months, and 6 months after surgery |