American University of Barbados, School of Medicine,  Wildey, Saint Michael, Barbados.

Perioperative management of patients receiving gynaecologic surgery has undergone a paradigm shift in the past decade that has transformed traditional, dogmatic approaches to perioperative care to evidence-based, multimodal pathways otherwise known as Enhanced Recovery After Surgery (ERAS). The extensive analysis in the literature conducted in the current paper reviews the literature published since 2013, providing a complete review of physiological principles, clinical use, and socioeconomic effect of ERAS protocols. Despite the universalism of the principles of ERAS, which may be attenuating the stress response preoperative state in the surgical context and preserving preoperative organ functions, their implementation in the Indian context creates a distinctive environment of adaptation. This report critically reviews information that relates to benign hysterectomy, complex gynaecologic oncology and caesarean sections with the highlight of the dichotomy between international guidelines and resource-constrained realities. Specific attention is given to the specific pharmacologic approaches used in Indian centres, economic justification of these approaches with the help of cost-effectiveness modelling, and sociocultural factors of compliance. The review ratifies the statement that despite the infrastructural difficulties, pragmatic, modified ERAS protocols can be implemented in Indian gynaecologic practice to a considerable extent to decrease the length of stay, morbidity, and healthcare expenses without interfering with patient safety.