Postoperative Gastrointestinal Function Recovery Research Articles

Comparison of laparoscopic retroperitoneal lymph node dissection vs.open surgery for clinical stageI-IInon- seminomatous germ cell tumor

Objective To explore the clinical effects of laparoscopic retroperitoneal lymph node dissection vs.open surgery for clinical stageⅠ-Ⅱnonseminomatous cell tumor. Methods Following the randomized controlled experiment method, the patients were randomly divided into two groups:11 cases of clinical stageⅠ-Ⅱnon- seminomatous cell tumor receiving laparoscopic retroperitoneal lymph node dissection, and in the same period, 11 receiving open surgery. Through the statistical analysis of the operative time, the intraoperative blood loss, mean dissected lymph node number, the postoperative hospital stay and the postoperative complication, the effect of two surgical procedures was compared. Results All cases were operated successfully without changing surgical approach.Between the laparoscopic and open groups, the mean operation time was(165±35) min vs.(176±41) min(P> 0.05), mean blood loss was(101±12) ml vs.(200±28) ml(P 0.05), mean postoperative gastrointestinal function recovery time was(1.6±0.3) days vs.(2.2±0.5) days(P< 0.05), and mean postoperative hospital stay was(7.5±2.8) days vs.(11.6±3.8) days(P< 0.05).No postoperative complications occurred in the laparoscope group.In the open group, there was one case of wound delayed healing and 1 case of high fever. Conclusion Laparoscopic retroperitoneal lymph node dissection is safe and effective with less trauma and faster recovery, and it can be used as first- line choice for diagnosis and treatment of clinical stageⅠ-Ⅱnonseminomatous cell tumor. Key words: Non- seminomatous cell tumor; Laparoscopic; Retroperitoneal lymph node dissection

Clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach

Objective To investigate the clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach. Methods The clinical data of 68 patients who underwent laparoscopic anatomical hepatectomy by Glissonean pedicle transection approach at the Southwest Hospital of Third Military Medical University between March 2009 and December 2013 were retrospectively analyzed. All the patients received intravenous-inhalation general anesthesia. The splitting of liver was carried out after Glissonean pedicles were completely dissected and occluded under the laparoscope according to anatomical structure. The patients with hepatolithiasis underwent intraoperative bile duct exploration and stone removal with T-tube placement based on the conditions of extrahepatic biliary lesions. The fragmented specimens from benign lesions of liver were taken out through a Trocar hole with the diameter of 12mm. The complete specimens from malignancy tumors of liver were taken out through an enlarged Trocar hole or transverse incision at the symphysis pubis. According to the recheck results of benign and malignancy lesions, the patients were followed up by outpatient examination and telephone interview till September 2014. The measurement data with normal distribution were presented as ±s. The survival curve was drawn by Kaplan-Meier method. Results Among the 68 patients, laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach was performed on 64 patients and 4 patients were coverted to open surgery. Laparoscopic anatomical left hemihepatectomy was performed on 30 patients, anatomical right hemihepatectomy on 19 patients, anatomical right posterior lobectomy on 10 patients and anatomical right anterior lobectomy on 9 patients. The mean operation time, volume of intraoperative blood loss, rate of perioperative blood transfusion, time of postoperative gastrointestinal function recovery and duration of hospital stay were (224±117) minutes, (413±349) mL, 5. 9% (4/ 68) , (3. 0±0. 5) days and (8. 0±3. 0) days, respectively. There was no perioperative death, and 6 patients with postoperative complication were cured by symptomatic treatment. The tumor diameter and distance to resection margin in 29 patients with malignancy tumors of liver were (4. 4 ± 1.6) cm and (2. 0±0.9) cm, respectively. The results of pathological examination showed that hepatolithiasis was detected in 22 patients, cavernous hemangioma of liver in 12 patients, hepatic focal nodular hyperplasia in 1 patient, hepatic adenoma in 1 patient, hepatic angiomyolipoma in 1 patient, hepatic multiple cysts in 1 patient, hepatic tuberculosis in 1 patient, hepatocellular carcinoma in 27 patients and cholangiocarcinoma in 2 patients. All the 68 patients were followed up for 6-60 months with a mean time of 24 months. No recurrence and residual stones or lesions in 39 patients with benign lesions of liver were detected during the follow-up. The 1-, 3-, 5-year overall survival rates and tumor-free survival rates in 29 patients with malignant tumors of liver were 92% , 84% , 60% and 83% , 59% , 42% , respectively. Conclusion Laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach is safe and feasible, and is suitable not only for left hemihepatectomy, but also for right hemihepatectomy of high technical specification. Key words: Liver neoplasms; Hepatolithiasis; Laparoscopy; Hepatectomy; Glissonean pedicle

Chewing gum for postoperative recovery of gastrointestinal function.

Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay (LOHS). Onset of ileus is considered to be multifactorial, and a variety of preventative methods have been investigated. Chewing gum (CG) is hypothesised to reduce postoperative ileus by stimulating early recovery of gastrointestinal (GI) function, through cephalo-vagal stimulation. There is no comprehensive review of this intervention in abdominal surgery. To examine whether chewing gum after surgery hastens the return of gastrointestinal function. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), MEDLINE (via PubMed), EMBASE (via Ovid), CINAHL (via EBSCO) and ISI Web of Science (June 2014). We hand-searched reference lists of identified studies and previous reviews and systematic reviews, and contacted CG companies to ask for information on any studies using their products. We identified proposed and ongoing studies from clinicaltrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform and metaRegister of Controlled Trials. We included completed randomised controlled trials (RCTs) that used postoperative CG as an intervention compared to a control group. Two authors independently collected data and assessed study quality using an adapted Cochrane risk of bias (ROB) tool, and resolved disagreements by discussion. We assessed overall quality of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Studies were split into subgroups: colorectal surgery (CRS), caesarean section (CS) and other surgery (OS). We assessed the effect of CG on time to first flatus (TFF), time to bowel movement (TBM), LOHS and time to bowel sounds (TBS) through meta-analyses using a random-effects model. We investigated the influence of study quality, reviewers' methodological estimations and use of Enhanced Recovery After Surgery (ERAS) programmes using sensitivity analyses. We used meta-regression to explore if surgical site or ROB scores predicted the extent of the effect estimate of the intervention on continuous outcomes. We reported frequency of complications, and descriptions of tolerability of gum and cost. We identified 81 studies that recruited 9072 participants for inclusion in our review. We categorised many studies at high or unclear risk of the bias' assessed. There was statistical evidence that use of CG reduced TFF [overall reduction of 10.4 hours (95% CI: -11.9, -8.9): 12.5 hours (95% CI: -17.2, -7.8) in CRS, 7.9 hours (95% CI: -10.0, -5.8) in CS, 10.6 hours (95% CI: -12.7, -8.5) in OS]. There was also statistical evidence that use of CG reduced TBM [overall reduction of 12.7 hours (95% CI: -14.5, -10.9): 18.1 hours (95% CI: -25.3, -10.9) in CRS, 9.1 hours (95% CI: -11.4, -6.7) in CS, 12.3 hours (95% CI: -14.9, -9.7) in OS]. There was statistical evidence that use of CG slightly reduced LOHS [overall reduction of 0.7 days (95% CI: -0.8, -0.5): 1.0 days in CRS (95% CI: -1.6, -0.4), 0.2 days (95% CI: -0.3, -0.1) in CS, 0.8 days (95% CI: -1.1, -0.5) in OS]. There was statistical evidence that use of CG slightly reduced TBS [overall reduction of 5.0 hours (95% CI: -6.4, -3.7): 3.21 hours (95% CI: -7.0, 0.6) in CRS, 4.4 hours (95% CI: -5.9, -2.8) in CS, 6.3 hours (95% CI: -8.7, -3.8) in OS]. Effect sizes were largest in CRS and smallest in CS. There was statistical evidence of heterogeneity in all analyses other than TBS in CRS.There was little difference in mortality, infection risk and readmission rate between the groups. Some studies reported reduced nausea and vomiting and other complications in the intervention group. CG was generally well-tolerated by participants. There was little difference in cost between the groups in the two studies reporting this outcome.Sensitivity analyses by quality of studies and robustness of review estimates revealed no clinically important differences in effect estimates. Sensitivity analysis of ERAS studies showed a smaller effect size on TFF, larger effect size on TBM, and no difference between groups for LOHS.Meta-regression analyses indicated that surgical site is associated with the extent of the effect size on LOHS (all surgical subgroups), and TFF and TBM (CS and CRS subgroups only). There was no evidence that ROB score predicted the extent of the effect size on any outcome. Neither variable explained the identified heterogeneity between studies. This review identified some evidence for the benefit of postoperative CG in improving recovery of GI function. However, the research to date has primarily focussed on CS and CRS, and largely consisted of small, poor quality trials. Many components of the ERAS programme also target ileus, therefore the benefit of CG alongside ERAS may be reduced, as we observed in this review. Therefore larger, better quality RCTS in an ERAS setting in wider surgical disciplines would be needed to improve the evidence base for use of CG after surgery.

Clinical effect of early laparoscopic cholecystectomy in the treatment of elderly patients with acute cholecysti-tis

Objective To investigate the clinical effect of early laparoscopic cholecystectomy in the treat -ment of elderly patients with acute cholecystitis .Methods 68 elderly patients with early acute cholecystitis were di-vided into the two groups according to the surgical procedures .33 cases in OC group were given traditional open sur-gery,while 35 cases in LC group received early laparoscopic cholecystectomy .The operative time,postoperative bowel recovery time and postoperative hospital stay time were compared between the two groups .Results The operative time,postoperative bowel recovery time ,postoperative hospital stay time in LC group were （43.7 ±5.8）min,（36.4 ± 3.9）h,（4.8 ±1.4）d,which were significantly shorter than （68.6 ±7.3）min,（65.2 ±4.5）h,（8.3 ±2.9）d in the OC group（t=3.317,3.862,3.029,all P〈0.05）.The incidence rate of postoperative complication of LC group was 14.29%,which of the OC group was 24.24%,the difference was not significant（P〉0.05）.Conclusion Early lap-aroscopic cholecystectomy in the treatment of elderly patients with acute cholecystitis can significantly shorten the operation time, promote postoperative recovery of gastrointestinal function and reduce postoperative hospital stay , reduce the burden of patients ,improve the quality of life and the incidence rate of complications is low . Key words: Cholecystitis,acute; Cholecystectomy,laparoscopic; Aged

Analysis on clinical value of retroperitoneal laparoscopic radical nephrectomy for the treatment of renal cell carcinoma

Objective To investigate the clinical efficacy and safety of retroperitoneal laparoscopic radical nephrectomy for the treatment of renal cell carcinoma.Methods 32 cases of renal cell carcinoma in our hospital were randomly divided into control group (received open radical nephrectomy) and observation group (received retroperitoneal laparoscopic radical nephrectomy).Operative time,intraoperative blood loss,postoperative gastrointestinal function recovery time,hospitalization time,complication rate and survival time of two groups were compared.Results Operative time of observation groups was (156.3 ± 42.1) min,which had no significant difference from control group (P ＞ 0.05).The intraoperative blood loss and hospitalization time of observation group were (132.6 ± 32.3) ml and (6.5 ± 1.7) d,which were significantly less than those of control group (P ＜ 0.05),postoperative gastrointestinal function recovery time was (29.3 ± 4.9) h,which was significantly longer than that of control group (P ＜ 0.05).Complication rate of observation group was 6.3％,which was significantly lower than that of control group (18.8％) (P ＜ 0.05).The survival time of two group had no significant difference (P ＞ 0.05).Conclusion Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma has exact effect with minimally invasive,less painful,less blood loss,shorter hospital stay and fewer complications. Key words: Renal cell carcinoma; Retroperitoneal laparoscopic; Radical nephrectomy

The Beneficial Effect of ST-36 (Zusanli) Acupressure on Postoperative Gastrointestinal Function in Patients With Colorectal Cancer

To evaluate the effectiveness of ST-36 (Zusanli) acupressure on recovery of postoperative gastrointestinal function in patients with colorectal cancer. A longitudinal, randomized, controlled trial design. An urban medical center in Taiwan. 60 patients with colorectal cancer who had undergone abdominal surgery. Patients were randomly assigned to two groups, the ST-36 acupressure group (n = 30) and a sham acupressure group (n = 30). Patients in the ST-36 group received an acupressure procedure in a three-minute cycle performed three times per day during the five days after surgery. Patients in the control group received routine postoperative care and sham acupressure. Generalized estimating equations (GEEs) were used to gauge longitudinal effects of the two groups of patients. Frequency of bowel sounds, the time to first flatus passage, first liquid intake, solid intake, and defecation. Patients who received acupressure had significantly earlier flatus passage and time to liquid intake as compared to patients in the control group. Other main variables, including the first time to solid intake and defecation, did not show significant difference between the two groups. The GEE method revealed that all patients had increasing bowel sounds over time, and the experimental group had greater improvement of bowel motility than the control group within the period of 2-3 days postoperatively. ST-36 acupressure was able to shorten the time to first flatus passage, oral liquid intake, and improve gastrointestinal function in patients after abdominal surgery. ST-36 acupressure can be integrated into postoperative adjunct nursing care to assist patients' postoperative gastrointestinal function. Few studies have explored the effectiveness of acupressure techniques on promoting bowel sounds. Evidence from this study suggests stimulation of the ST-36 acupressure point can increase bowel sound frequency for patients with colorectal cancer in the first three days after surgery. Application of this technique may improve a patient's comfort after surgery.

Laparoscopy with simultaneous ERCP for cholecystolithiasis combined with choledocholithiasis

Objective To investigate the feasibility of laparoscopy with simultaneous ERCP for cholecystolithiasis combined with common bile duct stones. Methods The clinical data of 150 cases with combined choledocholithiasis and eholecystolithiasis who underwent laparoscopy and simultaneous ERCP from November 2009 to March 2012 were analyzed retrospectively. Under general anesthesia, laparoscopic cholecystectomy （LC） was performed and followed by ERCP. Common bile duct stones were removed by ERCP and endoscopic nasobiliary drainage （ENBD）was placed. Therapeutic effect and complications were observed. Results LC and ERCP were successfully completed in all patients. There was no bleeding, perforation, severe pancreatitis or other severe complications occurred in any patient during and after operation. Postoperative gastrointestinal function recovery time and hospitalization were short. During follow-up, no residual or recurrent stones were found by abdominal ultrasound examination. Conclusion Simultaneous ERCP and laparoscopy is effective and safe treatment with less invasiveness and quick recovery for cholecys- tolithiasis combined with choledocholithiasis. Key words: Cholecystectomy, laparoscopic ; Cholangiopancreatography, endoscopic retrograde ; Cholecystolithiasis ; Choledocholithiasis

Tipps &amp; Tricks – Anästhesie bei laparoskopischen Eingriffen mit Kapnoperitoneum

Among clinical benefits like reduction in blood loss, faster postoperative recovery of gastrointestinal and lung function, lower rate of perioperative complications and less postoperative pain level, cost reduction by shortening of hospital stay plays a pivotal role for high incidence of laparoscopic surgery.Elevated intraabdominal pressure due to creation of pneumoperitoneum induces various pathophysiologic changes. Most of these changes are clinical inapparent in case of appropriate anesthesiologic management. This paper aims to sensibilize the anaesthesiologist for pathophysiologic changes, particularly with regard to hemodynamic and pulmonary complications, differential diagnosis and therapies.

Comparison of the Postoperative rehabilitation and life quality between cholecystitis laparoscopy and open resection

Objective To investigate the postoperative rehabilitation and life quality of cholecystitis laparoscopy and open resection.Methods 41 patients with laparoscopic surgery and 41 cases with general surgery,compared postoperative recovery of gastrointestinal function and to predict patients recovery from surgery.Results Observation group with postoperative recovery of gastrointestinal function was faster than control group [ ( 1.2 ± 0.2 ) d vs(2.1 ±0.4)d,P ＜0.05],postoperative gastrointestinal function with grade I was more than control group(21 vs 6)( P ＜ 0.05 ),C-reactive protein value was lower than control group after surgery [ ( 21.3 ± 3.4 ) mg/L vs ( 32.7 ± 5.3 ) mg/L,P ＜ 0.05 ],it had a short time to decreease to normal in observation group [ ( 11.2 ± 1.8 ) d vs ( 16.1 ± 2.4 ) d(P＜0.05) ].Conclusion Laparoscopic surgery compared with open cholecystectomy,it could reduce surgical trauma to the patient's stress,rapid recovery of postoperative gastrointestinal function,so it can improve the early postoperative quality of life. Key words: Cholecystectomy; laparoscopic; Treatment outcome; Quality of life

Clinical observation on recovery of post-operative gastrointestinal function treating neonatal intestinal atresia by “Taiduqing” umbilicus therapy

Objective To explore the effect of “Taiduqing“ Umbilicus Therapy on the recovery of the gastrointestinal functions in Neonatal intestinal atresia.Methods 100 post - operative patients with Neonatal intestinal atresia were divided into two groups with 50 patients for each group,The control group was treated with conventional western medicine therapy while the experimental group was treated with conventional western medicine therapy plus “Taiduqing”to the Umbilicus therapy.Then we observed the differences in needed time for restoration of bowel sound,the natural exhaust and ddtecation,abdominal distension and vomiting rate to the recovery of gastrointestinal function were evaluated.Results The total effective rate of the experimental group was 96.0％ (48/50),higher than that of the control group (74.0％) (P＜0.05) .The experimental group was better than the control group in the recovery of bowel sounds,natural exhaust,natural defecation,etc (P＜0.05).Conclusion “Taiduqing” Umbilicus Therapy can effectively promote the recovery of gastrointestinal function after neonatal abdominal surgery. Key words: Newborn; Intestinal atresia; Gastrointestinal function; Taiduqing; Umbilicus therapy

Clinical analysis of laparoscopic and endoscopic cooperative surgery in the treatment of gastric gastrointestinal stromal tumor: report of 46 cases

To evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for treating gastric gastrointestinal stromal tumors(GIST). Retrospective analysis was performed on the clinical data of 46 patients with gastric GIST undergoing laparoscopic and endoscopic cooperative surgery between June 2009 and June 2011 at the Renji Hospital of Shanghai Jiaotong University School of Medicine. There were 27 males and 19 females with the mean age of 58.5 years. Thirty-three patients received endoscopy-assisted wedge resection, and 13 cases received laparoscopy-assisted endoscopic resection. All the operations were successful. The mean operative time was (85.5±29.3) min, the mean blood loss was (31.4±12.2) ml, the mean post-operative gastrointestinal functional recovery time was (31.6±14.9) h, and the mean post-operative hospital stay was (5.1±2.9) d. No post-operative complication occurred. NIH risk assessment showed that 34 cases were very low risk and 12 low risk. No recurrence or metastasis was found during the follow-up ranging from 2 to 26 months(median, 12.6 months). Laparoscopic and endoscopic cooperative surgery for gastric GIST is both feasible and safe with minimal invasiveness, fast recovery and satisfactory short-term outcomes.

The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection

It is commonly perceived that surgery in obese patients is associated with worse outcomes than in nonobese patients. Because of the increasing prevalence of obesity and colonic diseases in the world population, the impact of obesity on outcomes of laparoscopic colectomy remains an important subject. The aim of this review was to evaluate the feasibility and safety of laparoscopic colectomy for colorectal diseases in obese patients compared with nonobese patients. We conducted a comprehensive review for the years 1983-2010 to retrieve all relevant articles. A total of 33 studies were found to be eligible and included 3 matched case control studies and 1 review article. Obesity, often accompanied by preexisting comorbidities, was associated with longer operative times and higher rates of conversion to open procedures mainly because of the problem of exposure and difficulties in dissection. Although some studies showed obesity was associated with increased postoperative morbidity including cardiopulmonary and systemic complications, or ileus leading to longer hospital stay, there was no evidence about the negative impact of obesity on intraoperative blood loss, perioperative mortality, and reoperation rate. Whether obesity is a risk factor for wound infection after laparoscopic colectomy remains unclear. Though sometimes in obese patients, additional number of ports were necessary to successfully complete the procedure laparoscopically, obesity did not influence the number of dissected lymph nodes in cancer surgery. Lastly, the postoperative recovery of gastrointestinal function was similar between obese and nonobese patients. Laparoscopic colorectal surgery appears to be a safe and reasonable option in obese patients offering the benefits of a minimally invasive approach, with no evidence for compromise in treatment of disease.

Effects of infusion of different fluids during controlled hypotension on gastric intramucosal pH and postoperative gastroenterological function

The present study was aimed to investigate the effects of infusion of different fluids combined with controlled hypotension on gastric intramucosal pH (pHi) and postoperative gastrointestinal function in patients undergoing hepatocarcinoma surgery. Forty-five patients (ASA II) scheduled for surgical resection of hepatocarcinoma undergoing controlled hypotension were randomly assigned to three groups and received infusion of 20 mL/kg Ringer's solution (R group), 6% HAES(H group) or 6% Voluven group (W group). Intragastric PgCO 2, pHi, hematocrit and hemoglobin were measured. The significant decrease of pHi and increase of PgCO 2 were produced at 1 and 2 h after controlled hypotension in the R group ( P < 0.05 or P < 0.01). The time of bowel movement after operation was shorter in the W group than the R group. Meanwhile, we also did not find obvious difference in blood gas indexes among the three groups. The infusion of HAES and Voluven during controlled hypotension could improve gastrointestinal perfusion and accelerate the recovery of postoperative gastrointestinal function.

Laparoscopic and open cholecystectomy in patients with acute cholecystitis the impact of gastrointestinal function and CRP

Objective To evaluate laparoscopic and open cholecystectomy for acute cholecystitis after the impact of gastrointestinal function and CRP. Methods 80 cases of acute cholecystitis and cholecystectomy were randomly divided into two groups. The laparoscopic group:40 underwent laparoscopic cholecystectomy.Laparotomy group:open cholecystectomy. Two groups of patients for evaluation of gastrointestinal function and CRP testing, were analyzed. Results Acute cholecystitis evaluation of gastrointestinal function. Laparoscopic group of 40 patients, Ⅰ grade 8 cases accounted for 20.0% , Ⅱ grade 15 cases accounted for 37.5% , Ⅲ grade 17 cases accounted for 42. 5%. Laparotomy group of 40 patients, Ⅰ 5 cases accounted for 12.5% , Ⅱ , 13 cases accounted for 32.5%, Ⅲ grade 22 cases accounted for 55.0%. Postoperative acute cholecystitis CRP test rating:laparoscopic group of 40 patients, normal in 6 cases accounted for 15.0% , slightly increased in 11 cases accounted for 27.5% , 40. 0% moderately elevated in 16 cases, severe increase of 7 cases 17.5%. Open group, 40 patients, normal in 2 cases(5.0%) , slightly increased in 13 cases (32. 5%), 35.0% moderately elevated in 14 cases, 11 cases of severe increased 27.5%. Conclusion The laparoscopic operation time was significantly lower than open surgery, avoiding the abdominal organs after abdominal exposure is conducive to rapid postoperative recovery of gastrointestinal function. Laparoscopy post-traumatic immune response than open surgery light. Key words: Acute cholecystitis; Laparoscopic cholecystectomy; Open cholecystectomy; Gastrointestinal function; CRP

Selective Postoperative Inhibition of Gastrointestinal Opioid Receptors

Postoperative recovery of gastrointestinal function and resumption of oral intake are critical determinants of the length of hospital stay. Although opioids are effective treatments for postoperative pain, they contribute to the delayed recovery of gastrointestinal function. We studied the effects of ADL 8-2698, an investigational opioid antagonist with limited oral absorption that does not readily cross the blood-brain barrier, on postoperative gastrointestinal function and the length of hospitalization. We randomly assigned 79 patients--including 1 whose surgery was canceled--to receive one capsule containing 1 mg or 6 mg of ADL 8-2698 or an identical-appearing placebo capsule two hours before major abdominal surgery and then twice daily until the first bowel movement or until discharge from the hospital. Data were analyzed for 26 patients in each of the three groups; all received opioids for postoperative pain relief. Observers who were unaware of the group assignments evaluated the outcomes. Fifteen patients underwent partial colectomy and 63 underwent total abdominal hysterectomy. Patients given 6 mg of ADL 8-2698 had significantly faster recovery of gastrointestinal function than those given placebo. The median time to the first passage of flatus decreased from 70 to 49 hours (P=0.03), the median time to the first bowel movement decreased from 111 to 70 hours (P=0.01), and the median time until patients were ready for discharge decreased from 91 to 68 hours (P=0.03). Effects in the group that received 1 mg of ADL 8-2698 were less pronounced. Selective inhibition of gastrointestinal opioid receptors by an antagonist with limited oral absorption that does not readily cross the blood-brain barrier speeds recovery of bowel function and shortens the duration of hospitalization.

The Effect of Analgesic Technique on Recovery of Patients after Colon Surgery

Background: Different types of analgesia may affect the rate of recovery of gastrointestinal function after colon surgery. Methods: Sixty-six patients undergoing colon surgery which including right and left hemicolectomy, anterior resection and Miles` operation were categorized into four groups. All groups received a general anesthesia. Control group, in surgical ward the patients received adjuvant analgesics on request postoperatively. Group M received a intraoperative bolus epidural morphine followed by an infusion of morphine. Group MB received a intraoperative bolus of epidural morphine followed by an infusion of bupivacaine and morphine. Group PCA received a intraoperative bolus of intravenous morphine followed by patientcontrolled morphine postoperatively. Results: Ambulation, oral feeding and duration of hospitalization were not differed among groups. Group MB, recovered gastrointestinal function approximately 30 hours earlier than Group PCA(p<0.05) Conclusion: Epidural analgesia with bupivacaine and morphine accelerated postoperative recovery of gastrointestinal function. (Korean J Anesthesiol 1998; 34: 383~388) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery

Choice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colonic surgery. Fifty-four patients undergoing partial colectomy surgery were randomized into four groups. All groups received a standardized general anesthetic. Group MB received a preoperative bolus of epidural bupivacaine and morphine followed by an infusion of morphine and bupivacaine. Group M received a preoperative bolus of epidural morphine followed by an infusion of morphine. Group B received a preoperative bolus of bupivacaine followed by an infusion of bupivacaine. Group P received a preoperative bolus of intravenous morphine followed by intravenous patient-controlled morphine postoperatively. All patients participated in a standardized recovery program to minimize the influence of nonanalgesic factors on recovery of gastrointestinal function. All epidural groups were double-blinded. All patients were deemed ready for discharge according to prospectively defined criteria. Groups B and MB reported superior analgesia with activity (P < 0.01). Group M had a greater incidence of pruritus (P < 0.05). Group B had a greater incidence of orthostatic hypotension (P = 0.04). Groups B and MB recovered gastrointestinal function and fulfilled discharge criteria approximately 1.5 days earlier than groups M and P (P < 0.005). Epidural analgesia with bupivacaine and morphine provided the best balance of analgesia and side effects while accelerating postoperative recovery of gastrointestinal function and time to fulfillment of discharge criteria after colon surgery in relatively healthy patients within the context of a multimodal recovery program.