Pain Management, Enhanced Recovery After Surgery (Eras) Protocol, and Intensive Care in Gynecologic Cancer Surgery

This chapter synthesizes current evidence on pain management, Enhanced Recovery After Surgery (ERAS) protocols, and postoperative intensive care (ICU) for gynecologic oncology surgery. We outline the expanding surgical spectrum—from minimally invasive procedures to extensive cytoreductive operations—and the implications for perioperative analgesia. Multimodal, opioid-sparing strategies that combine non-opioid analgesics (paracetamol, non-steroidal anti-inflammatory drugs, adjuvants), regional techniques (neuraxial and peripheral blocks), and patient education reduce opioid exposure, enable early mobilization, shorten length of stay, and improve patient-reported outcomes. ERAS-adherent pathways emphasize preoperative counseling, optimization of anemia and nutrition, anxiety management, goal-directed fluids, early enteral feeding, and procedure-specific pain algorithms. ICU considerations focus on high-risk cohorts—particularly elderly patients, ovarian cancer, and hyperthermic intraperitoneal chemotherapy (HIPEC) cases—and include vigilant monitoring for respiratory/circulatory failure, strict glycemic control, extended venous thromboembolism prophylaxis with low-molecular-weight heparin when appropriate, restrictive transfusion thresholds integrated with clinical context, and delirium prevention (including dexmedetomidine in selected elderly patients). For cytoreductive surgery and HIPEC, advanced hemodynamic guidance, meticulous fluid–electrolyte management, and early complication detection are pivotal. Future directions include personalized analgesia, prevention of chronic postsurgical pain, integration of non-pharmacologic therapies, and implementation science to improve real-world adherence and equity in ERAS delivery.