Enhanced Recovery After Surgery (ERAS) — MCQs

Question 11: All of the following are true about fast track surgery except?

• A. Fasting 6 hours for solids and 2 hours for liquids
• B. Use of romovac drain (Correct Answer)
• C. Elimination of pain by regional anesthesia
• D. Rapid postoperative mobilization

Explanation: **Explanation:** **Enhanced Recovery After Surgery (ERAS)**, also known as **Fast-Track Surgery**, is a multimodal, evidence-based approach designed to reduce the surgical stress response, maintain physiological function, and accelerate recovery. **Why "Use of romovac drain" is the correct answer (The Exception):** Traditional surgical teaching emphasized the routine use of drains ("When in doubt, drain it"). However, ERAS protocols advocate for the **avoidance of routine drainage** (including Romovac or other suction drains). Evidence shows that drains do not prevent anastomotic leaks or collections; instead, they increase the risk of infection, cause discomfort, and act as a physical barrier to early mobilization, which is a cornerstone of fast-track recovery. **Analysis of Incorrect Options:** * **A. Fasting 6 hours for solids and 2 hours for liquids:** This is a core ERAS principle. It moves away from "NPO after midnight" to reduce insulin resistance and dehydration. Clear carbohydrate drinks are encouraged up to 2 hours before induction. * **C. Elimination of pain by regional anesthesia:** ERAS emphasizes **multimodal analgesia** with an "opioid-sparing" approach. Regional techniques (like epidurals or plane blocks) are preferred as they provide superior pain relief without the side effects of opioids (nausea, ileus, sedation). * **D. Rapid postoperative mobilization:** Early ambulation (often starting on the day of surgery) reduces the risk of DVT, pulmonary complications, and muscle wasting. **High-Yield Clinical Pearls for NEET-PG:** * **Preoperative:** No bowel prep (usually), carbohydrate loading, and minimal premedication. * **Intraoperative:** Goal-directed fluid therapy (avoiding fluid overload) and maintenance of normothermia. * **Postoperative:** Early oral intake (avoiding prolonged NG tube use) and early removal of urinary catheters. * **Goal:** The primary goal of ERAS is to reduce the **length of hospital stay** and postoperative morbidity.