Postgraduate Medical Institute, University of Hull, Hull HU6 7RX, UK.
Br J Surg. 2011 Feb;98(2):181-96. doi: 10.1002/bjs.7331.
The introduction of enhanced recovery after surgery (ERAS) protocols has revolutionized preoperative and postoperative care. To date, however, the principles of enhanced recovery have not been applied specifically to patients undergoing breast surgery.
Based on the core features of ERAS, individual aspects of postoperative care in breast surgery were defined. A comprehensive search of MEDLINE, PubMed, Embase and the Cochrane Library database was performed from 1980 to 2010 to determine the best evidence for perioperative care in oncological breast surgery. A graded recommendation based on the best level of evidence was then proposed for each feature of ERAS.
Twelve core features of enhanced recovery after breast surgery were identified. Use of the thoracic block, from both analgesic and anaesthetic viewpoints, is well supported by evidence and should be encouraged. Trials specific to breast surgery regarding aspects such as perioperative fasting, preanaesthetic medication, prevention of hypothermia and postdischarge support are scarce, and evidence was extrapolated from non-breast trials. Trials on postoperative analgesia and prevention of postoperative nausea and vomiting in breast surgery are generally of small numbers. In addition, there is heterogeneity between studies.
This review suggests that the principles of enhanced recovery can be adopted in breast surgery. A 12-point protocol is proposed for prospective evaluation.
术后加速康复（ERAS）方案的引入彻底改变了术前和术后的护理方式。然而，迄今为止，加速康复的原则尚未专门应用于接受乳房手术的患者。
基于 ERAS 的核心特征，确定了乳房手术中术后护理的各个方面。从 1980 年到 2010 年，对 MEDLINE、PubMed、Embase 和 Cochrane Library 数据库进行了全面检索，以确定在肿瘤乳房手术中进行围手术期护理的最佳证据。然后，根据最佳证据水平，针对 ERAS 的每个特征提出了分级推荐。
确定了 12 个增强型乳房手术后恢复的核心特征。从镇痛和麻醉的角度来看，使用胸段阻滞都有充分的证据支持，应该鼓励使用。关于围手术期禁食、术前用药、预防低体温和出院后支持等方面的特定于乳房手术的试验很少，证据是从非乳房试验中推断出来的。关于乳房手术后镇痛和预防术后恶心和呕吐的试验通常数量较少。此外，研究之间存在异质性。
本综述表明，增强型恢复的原则可以应用于乳房手术。提出了一个 12 点方案，用于前瞻性评估。
