Perioperative Protocol of Ankle Fracture and Distal Radius Fracture Based on Enhanced Recovery after Surgery Program: A Multicenter Prospective Clinical Controlled study
Table 1
ERAS pathway of ankle and distal radial fractures.
Care process
Description
Preoperative
Patient education
Verbal counseling and written brochures provided
Oral multimodal analgesia
Oral NSAIDs to prevent hyperalgesia
No prolonged fasting
Clear liquids allowed up to 2 h and solids up to 6 h before anesthesia
Decreased sedative medications
Avoid the use of long-acting anxiolytics the night before surgery
Avoidance of urinary tubes
No routine urinary catheterization
Antibiotic prophylaxis
Antibiotics within 30 min before incision
Intraoperative
Prevention of hypothermia
Routine body temperature monitoring and active warming devices
Standard anesthesia protocol
Brachial plexus block recommended for distal radial fracture; combined spinal and epidural anesthesia and femoral and/or sciatic nerve block recommended for ankle fracture
Avoidance of drains
Meticulous hemostasis and no wound drains
Fluid management
Avoid too much hypertonic fluid, especially sodium-containing fluid
Postoperative
Multimodal analgesia
Multimodal opioid-free analgesia based on nerve block
Early feeding
Gradual oral intake of liquid sand solids after recovery from anesthesia
