Advances in the Clinical Application of Enhanced Recovery after Surgery (ERAS) Protocols in the Post-Anesthesia Care Unit (PACU)

Enhanced Recovery After Surgery (ERAS) has become a widely recognized perioperative management strategy aimed at minimizing physiological and psychological stress induced by disease, surgery, and anesthesia. It seeks to reduce postoperative complications, accelerate early recovery, and improve long-term outcomes. While ERAS protocols have been extensively implemented across the preoperative, intraoperative, and postoperative phases, their application in the post-anesthesia care unit (PACU) remains limited. Given the PACU’s pivotal role in early postoperative management, extending ERAS principles into this phase has garnered increasing attention as a means to enhance patient safety and recovery efficiency. This review summarizes the current clinical practices and recent advances in applying ERAS strategies within the PACU. Key areas include the prevention and management of pain, postoperative nausea and vomiting (PONV), and the early identification and treatment of postoperative delirium (POD) and delayed emergence. Additionally, the potential role of non-pharmacological interventions—such as acupuncture, transcutaneous electrical nerve stimulation (TENS), and traditional Chinese medicine therapies—in supporting pharmacologic management is discussed. Technological advancements in PACU monitoring, including continuous end-tidal CO₂ monitoring, bedside ultrasonography, and wearable physiological sensors, have significantly improved the early detection of respiratory and hemodynamic instability and enhanced extubation safety. The review also highlights often-overlooked aspects such as proactive temperature management to prevent perioperative hypothermia and the importance of addressing postoperative thirst to improve patient comfort. Beyond clinical interventions, optimizing PACU workflows is emphasized, including standardized handovers, environmental noise control, proper patient positioning, and structured staff training to enhance care quality and operational efficiency. Establishing dedicated PACU quality management systems and fostering multidisciplinary collaboration are essential for ensuring consistent implementation of ERAS principles. In conclusion, integrating ERAS protocols into PACU management holds significant potential to promote early postoperative recovery and improve patient-centered outcomes. Further research and structured implementation are needed to define best practices and optimize resource utilization for continuous improvement in this critical phase of perioperative care.