Postoperative ileus - an update on preventive techniques

被引:129
作者
Kehlet, Henrik [1 ]
机构
[1] Univ Copenhagen, Rigshosp, Sect Surg Pathophysiol, DK-2100 Copenhagen, Denmark
来源
NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY | 2008年 / 5卷 / 10期
关键词
fast-track surgery; laparoscopic surgery; nonopioid analgesia; peripheral opioid antagonists; postoperative ileus;
D O I
10.1038/ncpgasthep1230
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number of techniques have been demonstrated to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess. Early institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open or laparoscopic abdominal surgery can be reduced to 24-48 h in most patients. There is a need for data on the effect of these techniques on POI when applied to major upper abdominal Surgeries and emergency abdominal operations (e.g. trauma, peritonitis, etc.).
引用
收藏
页码:552 / 558
页数:7
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