Date Published: December 29, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): John B. Leslie, Eugene R. Viscusi, Joseph V. Pergolizzi, Sunil J. Panchal.
All patients undergoing bowel resection experience postoperative ileus, a transient cessation of bowel motility that prevents effective transit of intestinal contents or tolerance of oral intake, to varying degrees. An anesthesiologist plays a critical role, not only in the initiation of surgical anesthesia, but also with the selection and transition to effective postoperative analgesia regimens. Attempts to reduce the duration of postoperative ileus have prompted the study of various preoperative, perioperative, and postoperative regimens to facilitate gastrointestinal recovery. These include modifiable variables such as epidural anesthesia and analgesia, opioid-sparing anesthesia and analgesia, fluid restriction, colloid versus crystalloid combinations, prokinetic drugs, and use of the new peripherally acting mu-opioid receptor (PAM-OR) antagonists. Review and appropriate adaptation of these multiple modifiable interventions by anesthesiologists and their surgical colleagues will facilitate implementation of a best-practice management routine for bowel resection procedures that will benefit the patient and the healthcare system.
An anesthesiologist plays a critical role not only in the initiation of surgical anesthesia but also in the selection and transition to an effective maintenance of postoperative analgesia. All patients undergoing bowel resection (BR) experience postoperative ileus (POI), a transient cessation of bowel motility that prevents effective transit of intestinal contents or tolerance of oral intake, to varying degrees [1–3]. Clinically, POI is characterized by delayed passage of flatus and stool, bloating, abdominal distension, abdominal pain, nausea, and vomiting and is associated with an increase in postoperative morbidity and length of hospital stay (LOS) .
Postoperative GI dysmotility is the primary determinate of length of hospital stay after abdominal surgery [116, 117]. In the absence of multimodal treatment programs, mean hospital stay after colorectal surgery may be as long as 10 days [118–120]. A study of patients undergoing abdominal surgery revealed that the type and severity of the side effects of pain medications administered were more important to patients than postoperative pain control, highlighting the effect of POI on patient satisfaction . Management of POI and earlier return of GI function may result in improved patient satisfaction and decreased length of hospital stay.
J. B. Leslie received clinical research funding from Adolor, Wyeth Pharmaceuticals, and Progenics, and honoraria for presentation at CME-sponsored events or meetings funded by grants from GlaxoSmithKline and Adolor or to those organizations. E. R. Viscusi is a consultant for Adolor, and his institution has received grant support from Adolor and Progenics. He is also a speaker for Adolor, GlaxoSmithKline, and Wyeth. J. V. Pergolizzi is a consultant for Adolor, GlaxoSmithKline, and Grünenthal. S. J. Panchal is a speaker for Adolor and GlaxoSmithKline.