Post Operative Ileus Essay

369 Words 2 Pages
Alvimopan for post-operative ileus: What we should know

Post operative ileus is a distressing problem after gastrointestinal surgeries ( open or

laparoscopic ). It leads to a significant patient discomfort, prolonged hospital stay which

eventually adds to significant increase in overall cost of treatment. On many

occasions, ileus is the cause of readmission or re-exploration. Length of hospital stay

and discharge from the hospital is dependent on optimal bowel activity. The cause of

ileus is usually multifactorial. Bowel handling during surgery, resection and anastomosis

of intestines, surgical stress, inflammatory mediators, electrolyte imbalances, systemic

narcotics are
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Intravenous narcotics are the mainstay of post operative pain management after major

bowel surgeries. Although an epidural catheter is usually placed for providing pain

relief due to open surgeries, IV narcotics are used as a part of pain relief round the

clock or for breakthrough pain. Narcotics bind to µ receptors in the gut leading to


Post operative ileus is a consistent problem after colorectal surgeries. In view of that,

prophylactic measures are prescribed in the post-operative orders. Prokinetics like

metoclopramide are routinely a part of the post operative orders. Intravenous

levosulpiride, neostigmine and lignocaine are used in some resistant cases. Epidural

analgesia in the perioperative period is known to enhance bowel motility. Oral

prokinetic medications like mosapride or itopride is also used although it is difficult

to say how much drug gets absorbed in presence of gastroparesis. The oral route is

used because these drugs are not available in intravenous form. Aggressive

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