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Management of prolonged post‐operative ileus: evidence‐based recommendations
Author(s) -
Vather Ryash,
Bissett Ian
Publication year - 2013
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12102
Subject(s) - medicine , medline , ileus , tramadol , evidence based practice , vomiting , evidence based medicine , regimen , medical prescription , intensive care medicine , abdominal surgery , nausea , analgesic , surgery , anesthesia , alternative medicine , nursing , pathology , political science , law
Abstract Background Prolonged post‐operative ileus ( PPOI ) occurs in up to 25% of patients following major elective abdominal surgery. It is associated with a higher risk of developing post‐operative complications, prolongs hospital stay and confers a significant financial load on health‐care institutions. Literature outlining best‐practice management strategies for PPOI is nebulous. The aim of this text was to review the literature and provide concise evidence‐based recommendations for its management. Methods A literature search through the Ovid MEDLINE , EMBASE , G oogle S cholar and C ochrane databases was performed from inception to J uly 2012 using a combination of keywords and MeSH terms. Review of the literature was followed by synthesis of concise recommendations for management accompanied by Strength of Recommendation Taxonomy (either A, B or C). Results Recommendations for management include regular evaluation and correction of electrolytes (B); review of analgesic prescription with weaning of narcotics and substitution with regular paracetamol, regular non‐steroidal anti‐inflammatory drugs if not contraindicated, and regular or as‐required Tramadol (A); nasogastric decompression for those with nausea or vomiting as prominent features (C); isotonic dextrose‐saline crystalloid maintenance fluids administered within a restrictive regimen (B); balanced isotonic crystalloid replacement fluids containing supplemental potassium, in equivalent volume to losses (C); regular ambulation (C); parenteral nutrition if unable to tolerate an adequate oral intake for more than 7 days post‐operatively (A) and exclusion of precipitating pathology or alternate diagnoses if clinically suspected (C). Conclusions Recommendations have a variable and frequently inconsistent evidence base. Further research is required to validate many of the outlined recommendations and to investigate novel interventions that may be used to shorten duration of PPOI .