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Background: Modern surgery has shown that outcomes depend not only on the operation itself but also on how patients are prepared and cared for before and after it. Enhanced Recovery After Surgery (ERAS) programmes bundle evidence-based perioperative measures to reduce complications and length of stay. Sushruta divided surgical care into three stages, Purva Karma (preoperative), Pradhana Karma (operative) and Pashchat Karma (postoperative), with detailed instructions for each. Objective: To review Sushruta’s principles of perioperative care and compare them with the components and evidence of modern ERAS and surgical safety practice. Methods: Narrative and comparative review of Sushruta Samhita and of guidelines, meta-analyses and landmark studies on ERAS, preoperative fasting, infection prevention and surgical safety. Results: Sushruta’s Purva Karma includes assessment of the patient, preparation of instruments and materials, choice of auspicious and suitable timing, appropriate diet before surgery, and psychological preparation. His Pashchat Karma includes wound care, protection from infection by fumigation, diet, rest, avoidance of exertion, monitoring for complications and gradual return to activity. Several elements correspond to modern principles, such as patient optimisation, team preparation, infection prevention, nutrition, analgesia and early mobilisation. Other classical recommendations, such as prolonged rest, differ from ERAS, which emphasises early mobilisation and feeding. ERAS programmes reduce complications and length of stay in randomised trials. Conclusion: Sushruta’s perioperative framework anticipates the modern view of surgery as a continuum of care. Ayurvedic surgical practice can integrate classical principles with evidence-based ERAS elements, while updating recommendations that conflict with current evidence.

KEYWORDS: Purva Karma; Pashchat Karma; perioperative care; Enhanced Recovery After Surgery; ERAS; surgical safety; Sushruta; Shalya Tantra