Postoperative Ileus
What is paralytic postoperative ileus?
Postoperative ileus is defined as the uncomplicated ileus occurring following surgery, resolving spontaneously within 2-3 days. The term paralytic postoperative ileus is defined as ileus lasting more than 3 days after surgery. This prolonged inhibition can take days or weeks to resolve. The degree of ileus corresponds to intestinal inflammatory response.
In postoperative ileus (POI), inhibition of small bowel motility is transient, and the stomach recovers within 24-48 hrs, whereas colonic function takes 48-72 hours to return.
Discuss the treatment of postoperative ileus?
- NG tube- it provides relief of vomiting and bloating but do not shorten duration of ileus and may contribute to fever and atelectasis
- Early ambulation- little or no demonstrable effect on expediting the resolution of postoperative ileus.
- Early postoperative feeding via oral or NG tube may stimulate reflex for propulsive bowel motility. However its role remain unclear, because some studies support, whereas others refute, its benefits on shortening POI
- Laparoscopic procedures- generally have a decreased duration of POI
- Prokinetics including cisapride and erythromycin do not have a significant effect on the treatment of POI
- Laxatives-It may shorten the duration of POI, however clinical data proving effectiveness are lacking.
- NSAIDS-opiates alter GI motility and have the most profound effect on the colon. Limiting narcotic use in the postoperative patient can enhance the recovery of enteric motility. Opioid can be substituted by NSAIDs; however there is possible increased risk of postoperative bleeding
- Gum chewing- may shorten the duration of POI. It is simple and inexpensive; however there has been only one trial that was limited laparoscopic colectomy.
- Epidural anaesthetic/analgesics- this has beneficial effects on the duration of POI by blocking the inhibitory effect of sympathetic nervous system on gut motility.
In conclusion, the most important factors that could effect the duration and recovery from POI include limitation of the narcotic use, using alternative medications like NSAIDs and placing a thoracic epidural with local anaesthetics when possible. Selective use of NG decompression and correction of electrolyte imbalances also is important.
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