Enhanced Recovery After Surgery (ERAS) represents a paradigm shift in perioperative medicine, emphasizing a patient-centered, multimodal approach to optimize surgical outcomes, minimize complications, and expedite recovery. Originating from the pioneering work of Henrik Kehlet in colorectal surgery, ERAS protocols now extend across nearly all surgical disciplines, integrating evidence-based practices that replace traditional, high-stress perioperative routines. This chapter explores the physiologic foundations of ERAS and its key components—preoperative education, nutritional optimization, individualized fluid therapy, regional anesthesia, multimodal analgesia, and early mobilization. Anesthesiologists play a pivotal role in every phase of this process, coordinating multidisciplinary collaboration, guiding hemodynamic and metabolic optimization, and implementing opioid-sparing analgesic strategies that promote faster, safer discharge. Beyond direct patient care, anesthesiologists also drive institutional adoption, quality improvement, and cost-reduction initiatives that align ERAS with modern value-based healthcare. The continued evolution of ERAS, enhanced by digital health tools and precision-based perioperative analytics, positions anesthesiology at the forefront of surgical recovery innovation and systems leadership.