[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anaesthesia and ICU](https://durgical.com/en/anaesthesia/) › [Recovery and pain](https://durgical.com/en/anaesthesia/areas/recovery/) › Enhanced recovery after surgery (ERAS)

# Enhanced recovery after surgery (ERAS)

- Concept

ERAS is a team plan of small proven steps before, during and after surgery that helps patients eat, move and go home sooner and safer.

Updated Nov 13, 2026

## Key points

- ERAS is a bundle of evidence-based steps across the whole pathway; the benefit grows with compliance.
- Preoperative: counselling, optimisation, clear fluids until a couple of hours before anaesthesia and a carbohydrate drink, no routine long-acting sedatives.
- Intraoperative: short-acting agents, goal-directed fluids, normothermia, PONV prophylaxis and opioid-sparing multimodal analgesia.
- Postoperative: early eating, early mobilisation and early removal of drains, nasogastric tubes and catheters.
- Outcomes: shorter stay and fewer complications, without more readmissions.

## What it is

Enhanced recovery after surgery (ERAS) is a multimodal, evidence-based care pathway that aims to reduce the surgical stress response, keep body functions as normal as possible and speed recovery. It is not one intervention but a bundle of elements, each with modest benefit, that work best together and need a team of surgeons, anaesthetists, nurses, dietitians and physiotherapists plus regular audit of compliance. Before surgery: counselling so the patient knows what to expect, optimisation of anaemia, nutrition, smoking, alcohol and chronic disease, short fasting with clear fluids until a couple of hours before anaesthesia and a carbohydrate drink, avoidance of long-acting sedative premedication, and prophylaxis against infection, venous thromboembolism and nausea. During surgery: short-acting anaesthetic drugs, minimally invasive surgery where possible, goal-directed fluids that avoid both overload and hypovolaemia, normothermia, protective ventilation and opioid-sparing regional and multimodal analgesia. After surgery: early oral intake, early mobilisation, early removal of catheters, drains and nasogastric tubes, ongoing multimodal analgesia, and control of nausea and blood glucose. ERAS pathways shorten hospital stay and reduce complications without increasing readmissions, and they started in colorectal surgery but now cover many specialties.

## Key points

- The surgical stress response (catabolism, insulin resistance, fluid retention) slows recovery; ERAS aims to blunt it.
- A carbohydrate drink before surgery reduces insulin resistance and thirst; caution in patients with delayed gastric emptying.
- Routine bowel preparation, nasogastric tubes and drains are avoided unless there is a specific reason for the procedure.
- Opioid sparing reduces ileus, nausea and sedation, so patients eat and move sooner.
- Audit of compliance and outcomes is an ERAS element in its own right.

## Components

- Before admission: education, nutrition screening, correction of anaemia, stopping smoking and alcohol, prehabilitation.
- Day of surgery: short fasting, carbohydrate loading, antibiotic and thromboembolism prophylaxis, PONV risk assessment.
- In theatre: short-acting anaesthesia, regional techniques, balanced fluids, warming, protective ventilation.
- After surgery: multimodal analgesia, early diet, mobilisation on the day of or day after surgery, early catheter removal, clear discharge criteria.

## Step by step

- Counsel the patient and set expectations — informed patients mobilise and eat sooner.
- Optimise anaemia, nutrition, smoking and chronic disease — fitter patients have fewer complications.
- Shorten fasting and give a carbohydrate drink if suitable — reduces thirst, anxiety and insulin resistance.
- Use short-acting drugs, warming and goal-directed fluids — patients wake clearly and avoid overload.
- Plan opioid-sparing multimodal and regional analgesia — less ileus, nausea and sedation.
- Start eating, drinking and walking early and remove tubes early — keeps the gut and muscles working.
- Audit compliance and outcomes — gaps in the bundle are found and fixed.

## In practice

- Too much fluid causes gut oedema and ileus; too little causes poor perfusion: aim for a near-zero balance in stable patients.
- Thoracic epidural suits open abdominal surgery; for laparoscopic surgery, wound infiltration, plane blocks or spinal analgesia are common choices.
- Paracetamol and NSAIDs (if not contraindicated) form the base of analgesia, with opioids for rescue.
- Older and frail patients benefit too, but need extra attention to delirium, falls and nutrition.
- Discharge depends on criteria (pain controlled with oral drugs, eating, mobile, passing flatus, no complications), not on a fixed number of days.

## Next step

- Check that the ERAS elements for the procedure are documented in the chart and marked as done or not done.
- Ask the patient to drink, eat and walk on the day of surgery or the next day unless the surgeon says otherwise.
- Call a senior if the patient deviates from the pathway: uncontrolled pain, vomiting, fever, ileus, or failure to mobilise.
- Discharge on criteria and give clear advice on warning signs and who to contact.
- Arrange follow-up and record readmissions and complications for the audit.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main aim of an ERAS pathway?

To reduce the surgical stress response and keep normal function so the patient recovers faster, with fewer complications and a shorter stay.

## Why is a carbohydrate drink given before surgery in ERAS?

It reduces postoperative insulin resistance, thirst and hunger compared with prolonged fasting, and is safe as a clear fluid in most patients.

## Why does ERAS favour opioid-sparing analgesia?

Opioids cause ileus, nausea and sedation that delay eating and walking; regional and multimodal analgesia relieve pain with fewer of these effects.

## What happens to readmissions with ERAS?

They do not rise: ERAS shortens hospital stay and reduces complications without increasing readmissions.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anaesthesia/enhanced-recovery-after-surgery/)

## Elsewhere in DurgiPedia

- [Postoperative care on the ward: the first 24–48 hours](https://durgical.com/en/nursing/postoperative-care-on-the-ward-the-first-24-48-hours/)
- [Complications of immobility and how to prevent them](https://durgical.com/en/nursing/complications-of-immobility-and-how-to-prevent-them/)
- [Nutrition screening and helping patients eat](https://durgical.com/en/nursing/nutrition-screening-and-helping-patients-eat/)
- [The WHO surgical safety checklist](https://durgical.com/en/nursing/the-who-surgical-safety-checklist/)

## Connections

## Related 8

- [The pre-anaesthetic visit: history, examination and tests](https://durgical.com/en/anaesthesia/the-pre-anaesthetic-visit-history-examination-and-tests/)
- [Preoperative fasting: what and why](https://durgical.com/en/anaesthesia/preoperative-fasting-what-and-why/)
- [Postoperative nausea and vomiting](https://durgical.com/en/anaesthesia/postoperative-nausea-and-vomiting/)
- [Postoperative pain: multimodal analgesia](https://durgical.com/en/anaesthesia/postoperative-pain-multimodal-analgesia/)
- [Perioperative hypothermia and shivering](https://durgical.com/en/anaesthesia/perioperative-hypothermia-and-shivering/)
- [Epidural anaesthesia and analgesia](https://durgical.com/en/anaesthesia/epidural-anaesthesia-and-analgesia/)
- [Peripheral nerve blocks in principle](https://durgical.com/en/anaesthesia/peripheral-nerve-blocks-in-principle/)
- [Postoperative oliguria and fluids](https://durgical.com/en/anaesthesia/postoperative-oliguria-and-fluids/)

## Related conditions 1

- [Postoperative ileus](https://durgical.com/en/conditions/postoperative-ileus/)

## In Pharmacology 7

- [Paracetamol](https://durgical.com/en/pharmacology/paracetamol/)
- [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)
- [Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/)
- [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/)
- [5-HT3 receptor antagonists (setrons)](https://durgical.com/en/pharmacology/classes/5-ht3-receptor-antagonists/)
- [Heparins](https://durgical.com/en/pharmacology/classes/heparins/)
- [Cefazolin](https://durgical.com/en/pharmacology/cefazolin/)

[← All of anaesthesia](https://durgical.com/en/anaesthesia/)

Educational content; it does not replace supervised training, your institution's protocols or the anaesthetist's or intensivist's decision. It contains no doses and no ventilator or infusion settings.

Sources: [Anesthetic Management for Enhanced Recovery After Major Surgery (ERAS)](https://www.ncbi.nlm.nih.gov/books/NBK574567/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anaesthesia/enhanced-recovery-after-surgery/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anaesthesia/enhanced-recovery-after-surgery/