PERIOPERATIVE ANESTHETIC MANAGEMENT IN ENHANCED RECOVERY AFTER GYNECOLOGIC SURGERY: A NARRATIVE REVIEW

Abstract

Gynecologic surgery includes procedures ranging from minor ambulatory interventions to complex open operations for advanced malignancy. Anesthetic management has an important influence on postoperative pain, nausea and vomiting, gastrointestinal recovery, mobilization, length of hospitalization, and patient satisfaction. Enhanced Recovery After Surgery pathways integrate evidence-based anesthetic, surgical, nursing, and rehabilitative interventions to reduce the physiological stress of surgery and accelerate functional recovery. Important anesthetic components include preoperative assessment and counseling, avoidance of prolonged fasting, multimodal analgesia, opioid-sparing anesthesia, prevention of postoperative nausea and vomiting, maintenance of normothermia, rational fluid therapy, and early resumption of oral intake and activity. Regional techniques, including neuraxial analgesia and abdominal wall blocks, may provide benefit in selected patients, but their use should be adapted to the surgical approach and expected pain burden. Evidence published between 2014 and 2017 indicates that standardized enhanced recovery pathways can shorten hospital stay and reduce opioid exposure without increasing complications or readmissions after major gynecologic surgery. Successful implementation requires multidisciplinary cooperation, protocol adherence, clinical audit, and individualized management of patients with major comorbidities. This narrative review examines perioperative anesthetic strategies for women undergoing gynecologic surgery using references published from 2014 through 2017.