11.4 ERAS + Fast Track

Question 1

A 74-year-old patient is scheduled for a primary total hip replacement.

a) What are the potential benefits of an enhanced recovery (‘fast-track’) programme for this type of
surgery? (20%)

Answer 1

a) Potential benefits:

1. Early mobilisation (operative day if possible)
2. Decreased postoperative complications
   esp. cardiopulmonary
3. Decreased length of hospital stay
4. Cost reduction/theatre efficiency

Question 2

b) List the preoperative (30%), factors necessary for a ‘fast-track’ programme in this patient.

Answer 2

1 Appropriate patient selection

2 Patient education and motivation
delivered by multi-disciplinary team

3 Preoperative optimisation

4 Admit on the day of surgery
(staggered admissions if possible)

5 Use of carbohydrate loading
(clear complex carbohydrate drinks)
NB care with diabetics

Question 3

List the intraoperative (35%) factors necessary for a ‘fast-track’ programme in this patient.

Answer 3

Intraoperative factors:

Surgical technique:
minimise operative time,
avoidance of drains

Fluid management:
targeted fluid replacement

Tranexamic acid intraoperatively

Prevention of PONV,
e.g. avoidance of nitrous oxide, use of TIVA,
routine anti-emetics

Use long-acting opioids sparingly

Maintenance of normothermia

Use of quick offset anaesthetic agents
to allow rapid recovery

Question 4

List postoperative (15%) factors necessary for a ‘fast-track’ programme in this patient.

Answer 4

Use of multimodal analgesia/oral opioids (avoid PCA)

Encourage oral fluids early
and early nutrition (energy drinks)

Planned mobilisation and physiotherapy

Question 5

Principles of enhanced recovery formed
part of the model answer.

Answer 5

Principles of enhanced recovery formed
part of the model answer.

a) Potential benefits:

Early mobilisation (operative day if possible)

Decreased postoperative complications esp. cardiopulmonary

Decreased length of hospital stay

Cost reduction/theatre efficiency

b) Preoperative factors

Appropriate patient selection

Patient education and motivation
delivered by multi-disciplinary team

Preoperative optimisation

Admit on the day of surgery
(staggered admissions if possible)

Use of carbohydrate loading
(clear complex carbohydrate drinks)
NB care with diabetics

Intraoperative factors:
Surgical technique:
minimise operative time, avoidance of drains

Fluid management: targeted fluid replacement

Tranexamic acid intraoperatively

Prevention of PONV,
e.g. avoidance of nitrous oxide, use of TIVA,
routine anti-emetics

Use long-acting opioids sparingly

Maintenance of normothermia

Use of quick offset anaesthetic
agents to allow rapid recovery

Postoperative factors:
Use of multimodal analgesia/oral opioids
(avoid PCA)

Encourage oral fluids early and
early nutrition (energy drinks)

Planned mobilisation and physiotherapy