Health economic evaluation of patients with postoperative complications after colorectal surgery / 中华消化外科杂志

Postoperative complications of colorectal surgery are one of the most important reasons affecting patients' postoperative health and also an important factor increasing the burden of medical care. It can give policymakers a basis to the optimization of medical resources by clarifying the health economic burden of different postoperative complications through health economic evalua-tion. Through a detailed search of domestic and foreign literatures, the authors summarize and analyze the increased medical costs and prolonged hospital stays associated with postoperative anastomotic leak, surgical site infection, and postoperative ileus. Furthermore, the authors identify shortcomings in existing clinical studies of different mediacal centers for colorectal postoperative complications, in order to better guide future clinical researches related to colorectal postoperative complications.

Postoperative ileus after laparotomy for gastrointestinal cancer treated with electroacupuncture: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on postoperative ileus after laparotomy for gastrointestinal cancer.@*METHODS@#A total of 90 patients with postoperative ileus after laparotomy for gastrointestinal cancer were randomized into an EA group and a conventional treatment group, 45 cases in each one. In the conventional treatment group, the postoperative fast track surgical regimen was accepted. In the EA group, on the base of the treatment as the conventional treatment group, acupuncture was applied to Zusanli (ST 36), Shangjuxu (ST 37), Yinlingquan (SP 9) and Taichong (LR 3) and electric stimulation was attached on Zusanli (ST 36) and Yinlingquan (SP 9), with continuous wave, 2 Hz in frequency and 3-5 mA in intensity. Acupuncture was provided once daily till the onset of postoperative exhaust and defecation. The first postoperative exhaust time, the first postoperative defecation time, the postoperative hospital stay and the wound pain under standing on the next morning after entering group were compared in the patients between the two groups. The impact of the EA expectation was analyzed on the first postoperative exhaust time, the first postoperative defecation time and the postoperative hospital stay separately.@*RESULTS@#The first postoperative exhaust time and the first postoperative defecation time in the EA group were earlier than the conventional treatment group (P<0.05), the postoperative hospital stay was shorter than the conventional treatment group (P<0.05), and the rate of wound pain in the postoperative standing was lower than the conventional treatment group (P<0.05). EA expectation had no obvious correlation with the clinical therapeutic effect (P>0.05).@*CONCLUSION@#EA can relieve postoperative ileus symptoms, alleviate pain and shorten hospital stay in the patients after laparotomy for gastrointestinal cancer.

Negative effect of prolonged postoperative ileus on postoperative recovery in patients underwent open alimentary tract surgery / 国际外科学杂志

Objective:To analyze the negative effect of prolonged postoperative ileus on postoperative recovery in patients underwent open alimentary tract surgery.Methods:This study was a retrospective cohort study. The subjects of the study were patients who underwent open gastrointestinal surgery at the General Surgery Department of Beijing Friendship Hospital, Capital Medical University from October 2016 to November 2018. According to the PPOI diagnostic criteria proposed by the University of Auckland, the included patients were classified as PPOI Group ( n=14) and non-PPOI group ( n=112). The postoperative complications, postoperative hospital stay and medical expenses during hospitalization were selected as the study endpoint indicators. T-test or Fisher′s exact test were performed to compare the differences between the two groups, and linear regression analysis was used to explore the independent effects of PPOI on hospital stay and medical expenses. Results:The incidence of PPOI in this study cohort was 11.1%. The total postoperative complications occurred more frequent in PPOI group (64.29% vs 38.39%, P=0.08). The average postoperative hospital stay of patients in the PPOI group was longer than that in non-PPOI group [(21.21±14.83) d vs (13.98±14.21) d, P=0.070]. Adjusting for various possible confounding factors, the PPOI regression coefficient beta (95% CI) that affects the length of hospital stay was [-0.43 (-7.16, 6.3), P=0.90]. The average medical cost of patients in the PPOI group was more than that in non-PPOI group [(104 389.64±52 427.66)元比(79 111.41±50 832.29)元, P=0.070]. Adjusting for various possible confounding factors, the PPOI regression coefficient beta (95% CI) that affects medical expenditure was [-134.12 (-21656.85, 21388.62), P=0.99]. Conclusions:Prolonged postoperative ileus leads to delayed postoperative recovery, which is related to increased postoperative complications, hospital stay duration and medical cost. But it needs further confirmation from large sample data.

The effect of caffeine ingestion in prevention of post-operative ileus after caesarean section: a randomized controlled trial

Background: Caesarian section (CS) has become more prevalent than the vaginal delivery in Egypt. Many complications could occur after an abdominal surgery. One of the commonest but yet serious complications is the postoperative ileus that can possibly be prevented by caffeine ingestion. The aim of the study is to assess the value of caffeine ingestion in promoting intestinal motility and prevention of postoperative ileus after CS.Methods: This is a randomized controlled trial that was conducted on 560 cases who were recruited from emergency unit and inpatient wards in Ain Shams University maternity hospital. The patients were divided into two groups where the intervention group received caffeinated coffee while the other group received decaffeinated coffee.Results: There was statistically significant difference between the two groups regarding the bowel function after CS (p <0.05). The intervention group had improved intestinal functions after the CS. Patients from the intervention group had audible intestinal sound sooner than the control group. In addition, they passed flatus and were able to tolerate food in less time.Conclusions: Consuming caffeinated coffee after CS contributes significantly to faster restoration of intestinal function. Coffee is a popular drink and can be used to decrease the incidence of postoperative ileus-related complications.

Effects of ulinastatin on rat postoperative ileus and intestinal barrier function / 中国药理学通报

Aim To study the effect of ulinastatin(UTI) on postoperative ileus(POI) and the intestinal barrier function in SD rats. Methods UTI was injected in three doses before, after and during abdominal surgery in SD rats. Evans blue was given by gavage 48 hours after the surgery and gastrointestinal propulsion rate was measured 30 minutes later. The end of ileum was collected for HE staining and AB/PAS staining to make tissue sections. The morphology of the intestinal villi and the number of goblet cells were observed under a light microscope. D-lactate and endotoxin kits were used to evaluate intestinal permeability. cDNA was extracted from the intestinal tissues to detect the levels of inflammatory factors and intestinal barrier-related genes by qPCR. Results In POI model group, the gastrointestinal propulsion rate decreased, and villi structure of small intestine was severely damaged; the levels of D-lactate, endotoxin and inflammatory factor mRNA increased; the number of goblet cells in crypt increased; the levels of MUC2 and MUC3 mRNA increased; the level of HD5 mRNA decreased. Pretreatment with medium dose UTI could significantly reverse the above situation. Conclusions Pretreatment with medium dose UTI can effectively reduce the intestinal inflammation and restore partially the intestinal barrier function in POI rats, thus preventing and treating the decrease of gastrointestinal propulsion rate caused by POI.

Effect of Houpu Sanwu Tang on Small Intestine Interstitial Cells of Cajal and iNOS in Postoperative Ileus Rats / 中国实验方剂学杂志

Objective: To evaluate the effect of Houpu Sanwu Tang on the postoperative ileus (POI), and observe its underlying mechanisms of action on interstitial cells of cajal (ICC) and inducible nitric oxide synthase(iNOS) regulation of POI. Method: Totally 87 healthy adult male SD rats were randomly divided into sham operation group, saline control group and Houpu Sanwu Tang group at low, medium and high doses. Houpu Sanwu Tang low, middle and high dose groups received orally Houpu Sanwu Tang(2.25,4.5,9 g·kg-1); Sham operation group (Sham operation) and saline control group (Saline control) received orally normal saline. Surgical procedure was used to induce the postoperative ileus. Changes in intestinal propulsion rate, intestinal mucosal injury and small intestine expression of c-kit and iNOS among these groups were detected. Result: Intestinal propulsion rate was significantly higher in Houpo Sanwu Tang group than that in Saline control group (PPPPConclusion: Houpu Sanwu Tang can improve the intestinal propulsion rate and the recovery in POI rats. The mechanisms are related to the inhibition of the generation of iNOS, the alleviation of inflammatory response, and increase of the number of ICC, so as to ensure its normal function, and improve the intestinal dynamic disorder.

Effect and mechanism of electroacupuncture for postoperative ileus at perioperative stage / 中国针灸

<p><b>OBJECTIVE</b>To observe the intervention effect of electroacupuncture (EA) on small intestinal motility in the rats of postoperative ileus (POI) at perioperative stage and explore the mechanism on the regulation of interstitial cells of Cajal (ICC) in the treatment of POI.</p><p><b>METHODS</b>Sixty heathy male SD rats were randomized into a sham-operation group, a model group, an EA group and a sham-EA group, 15 rats in each one. Except the sham-operation group, POI modeling was done in the rest groups. In the EA group, separately, 48 h, 24 h and 0.5 h before modeling, during modeling and 6 h, 12 h and 24 h after modeling, EA was given bilaterally to "Zusanli" (ST 36), 5 Hz, 1-2 mA, for 30 min. The sham-EA stimulation was given in the sham-EA group at the same time points. The same fixation was the only intervention in the model group. No intervention was applied in the sham-operation group. Five rats were selected randomly from each group 6 h, 12 h and 24 h after modeling for the determination of small intestine motility and they were sacrificed. Afterwards, the small intestinal muscular layer was collected for the determination of c-kit and P2X7 mRNA. In 24 h of modeling, the immunofluorescence test was done for c-kit determination.</p><p><b>RESULTS</b>In 6 h, 12 h and 24 h of modeling, in the model group, the EA groupand the sham-EA group, the small intestine motility was apparently lower than that in the sham-operation group at the same time points (all<0.01). In 6 h and 12 h of modeling, the small intestine motility in the EA group was not different significantly as compared with that in the model group (both>0.05). In 24 h of modeling, the small intestine motility in the EA group was better than that in the model group and the sham-EA group at the same time points (both<0.05). The difference was not significant between the sham-EA group and the model group (>0.05). In 6 h, 12 h and 24 h of modeling, c-kit mRNA expression of small intestine muscular layer was reduced apparently in the model group (all<0.01) and P2X7 mRNA expression did not change apparently (all>0.05). In 24 h of modeling, as compared with the model group and the sham-EA group, c-kit mRNA expression and positive cell area in the small intestine muscular layer were increased in the EA group (all<0.01).</p><p><b>CONCLUSIONS</b>EA effectively increases the small intestinal motility in POI rats, shortens the recovery time, which is probably closely relevant with the increase of ICC count in small intestinal muscular layer.</p>

Effect of perioperative administration of dexmedetomidine on postoperative ileus after laparocolectomy / 临床麻醉学杂志

Objective To evaluate the effect of perioperative administration of dexmedetomidine on postoperative ileus after laparocolectomy.Methods Sixty patients scheduled for abdominal surgery were randomly divided into two groups,30 in each group.Group D received dexme-detomidine administeration at a loading dose of 0.6 μg/kg for 10 minutes before induction,followed by an infusion rate of 0.5 μg·kg-1 ·h-1 to 30 min before the end of surgery.The control group re-ceived saline instead of Dex.After the surgery,Group C received intravenous sufentanyl 2 μg/kg, while group D sufentanyl 2 μg/kg combined with Dex 2 μg/kg.Heart rate variability (HRV)were detected before Dex infusion (T0 ),10 minutes after intubation (T1 ), 10 minutes after CO 2 insufflation (T2 ),1 hour after CO 2 insufflation (T3 ),10 minutes after CO 2 desufflation (T4 ),and 10 minutes after extubation(T5 ).The plasma concentrations of epinephrine(E)and norepinephrine (NE)were determined at T0 ,T3 ,T5 ,T7 and T1 0.The recovery of bowel function was evaluated in terms of the first time to fart and intake food.Results Compared with T0 ,HRV of power (TP), high-frequency (HF)power,low-frequency (LF)power and the ratio of LF/HF power were signifi-cantly decreased at T1-T4 in group C and at T1-T5 in group D.The plasma concentrations of E and NE were higher at T3 ,T5 ,T7 and T1 0 in both group C and group D (P <0.05).Compared with T1 ,TP, LF and the ratio of LF/HF were increased at T2-T4 (P <0.05).Compared with group C,TP,LF and the ratio of LF/HF were decreased at T2-T5 ,The plasma concentrations of E and NE were decreased at T3 ,T5 ,T7 and T10 and the time of first flatus was earlier(P <0.05).Conclusion The perioperative ad-ministration of dexmedetomidine during laparocolectomy facilitated the early recovery of bowel func-tion after surgery and decreasede the time of postoperative ileus.

Advances in the Modern Studies of Acupuncture Treatment of Postoperative Ileus / 上海针灸杂志

Postoperative ileus (POI) is a common abdominal postoperative complication of surgery as well as obstetrics and gynecology. There is a lack of an effective method of modern medicine due to its complex pathophysiological mechanism and the postoperative physiological disorder of patient. Acupuncture has remarkable regulatory effects on gastrointestinal function. Some clinical studies indicated that acupuncture was an effective method to treat POI, which could reduce the duration of POI and the treatment costs of patients in hospital. However, the mechanism and law of acupuncture on treating POI is still unclear. Some clinical studies indicated that the regulatory effect of acupuncture on the gastrointestinal motility was associated with its regulation of the autonomic nerve system and immune system. Based on its effect on regulating autonomic nerve system and immune system, acupuncture would be a potential and safe treatment for POI.

Comparative study on three preparation methods of mouse postoperative ileus models / 国际药学研究杂志

Objective By observing the motility changes of the gastrointestinal tract in mouse postoperative ileus (POI) models prepared with three different methods, this study aims to compare the features of three types of models, and judge their suitability for drug evaluation. Methods Three methods were conducted to prepare the mouse POI models: air exposure, friction and extrusion. In the experiment, the gastric emptying rate, intestinal propulsive rate as well as the relatively percent dextran of blue-2000 in intestinal paragraphs were taken down to evaluate the motility of gastrointestinal tract. Meanwhile, the duodenum, jejunum, ileum and colon of mice were stained in HE method to observe the histopathological changes of each layer in mouse intestinal wall. Results When compared with the control group, the gastric emptying rate of the squeeze-only group was significantly suppressed (P < 0.01). The intestinal propulsive rate in the air exposure group, the friction group and the extrusion group were all suppressed, only the friction group and the extrusion group had statistical difference (P < 0.01). The relative percent of dextran blue-2000 in intestinal paragraphs in mice also show that the motility of the mouse gastrointestinal tract in both the friction and extrusion groups was significantly inhibited. Judging from the results of HE staining, the duodenums of mice in the air exposure group, friction group and extrusion group did not show much difference when compared with the control group. While for the jejunum, the intestinal mucosa and submucosa of mice in the squeeze group had a large quantity of hemorrhage and inflammatory cell infiltration. For the ileum and colon, the friction and extrusion groups showed different degrees of inflammatory cell infiltration, and the mice in the extrusion group suffered from ileal hemorrhage. Conclusion All the three preparation methods of mouse POI models can inhibit the intestinal movement of mice. The effect of the air exposure method causes the light injury. The extrusion method, which causes more serious injury, could be used in the study of the pathogenesis of postoperative ileus.The friction method that has a moderate damage to the intestine, is more suitable for drug screening and evaluation.

Idiopathic meconium peritonitis as a surgical emergency: A case report in a newborn / Peritonitis meconial idiopática como urgencia quirúrgica. Reporte de caso en una recién nacida

Meconium peritonitis is a rarely described condition that is typically found in fetal and perinatal patients. It manifests in different ways and requires an early diagnosis. In this case report, a clinical suspicion of the disease was made at the antenatal period through an obstetric ultrasound scan showing an abdominal mass in both the bottom and top right quadrants. The patient initial symptoms were those of acute intestinal obstruction. Nevertheless, these symptoms improved after surgical approach was timely performed. Based on this outcome, it can be concluded that a favorable outcome to this pathology depends on its early diagnosis, since an early diagnosis decreases morbidity and mortality chances.

La peritonitis meconial es una entidad poco descrita, propia de la edad fetal y perinatal, que se presenta de diversas formas y requiere un diagnóstico temprano. En el presente caso se realiza sospecha clínica desde el periodo antenatal, por medio de una ecografía obstétrica que muestra una masa abdominal ocupando el cuadrante derecho inferior y superior. La paciente inicia con síntomas agudos de obstrucción intestinal que mejoran luego de un abordaje quirúrgico oportuno. De acuerdo a lo anterior, se concluye que un desenlace favorable en esta patología depende de un diagnóstico temprano, pues a través del mismo se disminuyen las probabilidades de morbilidad y mortalidad

The Effects of Prucalopride on Postoperative Ileus in Guinea Pigs

PURPOSE: Postoperative ileus (POI) is an impairment of coordinated gastrointestinal (GI) motility that develops as a consequence of abdominal surgery and is a major factor contributing to patient morbidity and prolonged hospitalization. The aim of this study was to investigate the effects of different 5-hydroxytryptamine 4 (5-HT4) receptor agonists, which stimulate excitatory pathways, on a POI model. MATERIALS AND METHODS: The experimental model of POI in guinea pigs was created by laparotomy, gentle manipulation of the cecum for 60 seconds, and closure by suture, all under anesthesia. Different degrees of restoration of GI transit were measured by the migration of charcoal. Colonic transit was indirectly assessed via measurement of fecal pellet output every hour for 5 hours after administration of various doses of mosapride, tegaserod, prucalopride, and 5-HT. RESULTS: Charcoal transit assay showed that various 5-HT4 receptor agonists can accelerate delayed upper GI transit in a dose-dependent manner. However, fecal pellet output assay suggested that only prucalopride had a significant effect in accelerating colonic motility in POI. CONCLUSION: Although mosapride, tegaserod, and prucalopride produce beneficial effects to hasten upper GI transit in the POI model, prucalopride administered orally restores lower GI transit as well as upper GI transit after operation in a conscious guinea pig. This drug may serve as a useful candidate for examination in a clinical trial for POI.

Inflammatory Responses in the Muscle Coat of Stomach and Small Bowel in the Postoperative Ileus Model of Guinea Pig

PURPOSE: Small intestinal function returns first after surgery, and then the function of the stomach returns to normal after postoperative ileus (POI). The aim of this study was to investigate inflammatory responses in the muscle coat of stomach and small intestine in guinea pig POI model. MATERIALS AND METHODS: The distance of charcoal migration from pylorus to the distal intestine was measured. Hematoxylin and eosin (H&E) and immunohistochemical stain for calprotectin were done from the histologic sections of stomach, jejunum and ileum obtained at 3 and 6 hour after operation. Data were compared between sham operation and POI groups. RESULTS: The distance of charcoal migration was significantly reduced in the 3 and 6 hour POI groups compared with sham operated groups (p<0.05). On H&E staining, the degree of inflammation was significantly higher in the stomach of 3 hour POI groups compared with jejunum and ileum of POI groups or sham operated groups (p<0.05). Calprotectin positive cells were significantly increased in the muscle coat of stomach of 3 hour POI groups compared with jejunum and ileum of POI groups or sham operated groups (p<0.05). There was strong association between the degree of inflammation and calprotectin positive cells in stomach. CONCLUSION: Postoperative ileus induced by cecal manipulation significantly increased the degree of inflammation and calprotectin positive cells in the muscle coat of stomach as a remote organ. The relevance of degree of inflammation and the recovery time of ileus should be pursued in the future research.

The effect of erythromycin on gastrointestinal motility in subtotal gastrectomized patients / 대한외과학회지

PURPOSE: Our objective was to determine the effect of erythromycin (EM) in improving gastrointestinal motility in subtotal gastrectomized patients. We used radio-opaque Kolomarks as an objective method. We conducted a prospective, controlled clinical trial study of 24 patients. METHODS: All patients underwent subtotal gastrectomy with 3 capsules containing Kolomarks (20 markers per 1 capsule) in the remnant stomach before anastomosis. From the day of the operation to the 2nd postoperative day, patients in the EM group began receiving 200 mg of EM intravenously for 30 minutes continuously. We counted the number of Kolomarks in the stomach, passed by stomach, in rectum, and in stool with serial simple abdominal X-ray films on the first postoperative day up to the 7th postoperative day. RESULTS: The study population included 14 patients in the control group and 10 patients in the EM group. The two study groups were compared in terms of their characteristics including age, gender, past medical history, cancer stage, and operation type. No significant differences were found for the demographics between the two groups. We only found a significant difference for the number of Kolomarks passed by the stomach on the 3rd postoperative day (P = 0.026). CONCLUSION: Our results demonstrated that 200 mg of EM intravenous infusion during the postoperative period induced rapid gastric emptying, although it did not improve gastrointestinal motility for the entire gastrointestinal tract in subtotal gastrectomized patients.

Effects of Houpupaiqi mixture on recovery of gastrointestinal function after open gastrointestinal surgery:a multi-center prospective study / 中华消化外科杂志

Objective To investigate the effects of Houpupaiqi mixture on the recovery of gastrointestinal function after open gastrointestinal surgery,and evaluate the efficacy and safety of Houpupaiqi mixture.Methods A total of 144 selected patients who underwent open gastrointestinal surgery were enrolled into the multi-center prospective randomized double-blind controlled clinical trial from October 2010 to September 2011.Of the 144 patients,66 were from People's Hospital of Peking University,72 were from Beijing Friendship Hospital of Capital University of Medical Sciences,and 6 were from People's Hospital of Guangdong Province.All the patients were randomly divided into 2 groups (test group:96 patients,control group:48 patients) at the ratio of 2∶1 according to the random number table.Five patients who did not meet the criteria were excluded from the study,and then there were 92 patients in the test group and 47 patients in the control group.The study was assessed by the ethics committees,and all the patients signed the informed consent form.Houpupaiqi mixture (50 ml) or placebo (50 ml) were administered in the test group and control group at postoperative 16 and 20 hours,respectively.Parenteral and enteral nutritional support were given after pulling out of gastric tube.A standard intravenous analgesia was applied in the 2 groups,and agents which stimulate or suppress gastrointestinal motility were prohibited.The time for the recovery of regular bowel sounds,the first exhaust and first defecation time,and the time of first solid food intake of the 2 groups were recorded.Vital signs were recored before operation and after drug administration.Blood and urinary routine test,hepatic and renal function test,electrocardiogram examination,record of adverse drug event were carried out at postoperative day 6.The time for the indexes above and relevant frequencies were calculated,and the survival curve were drawn by Kaplan-Meier method.All the time points were analyzed using the Log-rank test.The measurement data were analyzed using the t test or rank-sum test,and the enumeration data were analyzed using the chi-square test or Fisher exact probability.Results The median time for the recovery of regular bowel sounds,median time for first exhaust and defecation were 21.4 (20.0,23.7)hours,45.0 (40.0,54.0) hours and 65.5 (54.7,74.0) hours in the test group,and 47.5 (44.0,56.5) hours,91.0 (87.0,93.8)hours,98.0 (94.0,113.5)hours in the control group,there were significant differences between the 2 groups (Log-rank values =21.67,53.15,11.81,P＜0.05).The median time of first solid food intake were 72.5 (66.2,110.5) hours of the test group and 116.3 (114.8,117.3) hours of the control group,with no significant difference between the 2 groups (Log-rank value =13.70,P ＞ 0.05).There were no significant differences in the body temperature,respiration,heart rate,systolic blood pressure and diastolic blood pressure before and after medication between the 2 groups (Z =0.03,0.68,0.97,0.22,0.72,P ＞ 0.05).There were no significant differences in the number of patients with abnormal results of blood test,hepatic function,renal function and electrocardiogram between the 2 groups (P ＞ 0.05).No severe adverse event was observed in the clinical trial.Conclusion Houpupaiqi mixture significantly promotes the recovery of gastrointestinal function of the patients who underwent open gastrointestinal surgery with relatively low adverse events.

Can Gum Chewing Reduce Postoperative Ileus after Open Abdominal Surgery?

PURPOSE: Gum chewing activates chephalic-vagal reflex as in food consumption and increases the release of gastrointestinal hormones which are related with gut motility. The objective of this study was to assess whether it is effective in shortening the time of hospitalization and postoperative ileus. METHODS: Twenty patients who received open abdominal surgery for colon cancer in Gachon University, Gil Hospital were collected. They were further categorized to gum-chewing group (n=10, mean age=52.0 years, range 37 to 70) and control group (n=10, mean age=59.7 years, range 35 to 75) randomly. The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until the day they began oral intake. The time of gas out was recorded in each group. RESULTS: The mean time of gas out were 2.35 days (SD 1.2) in gum-chewing group and 2.87 days (SD 1.2) in control group (P=0.41). The mean postoperative hospital days were 10.5 days in gum-chewing group and 13.0 days in control group (P=0.23). CONCLUSION: There were no statistically significant results for shortnening of postoperative ileus and hospital day in this study.

The Effect of Dexpanthenol in Postoperative Patients

PURPOSE: The purpose of this study was to compare the efficacy of dexpanthenol in postoperative patients. Dexpanthenol, the alcohol derivative of pantothenic acid, is believed to be a precursor of acetylcholine through its incorporation into coenzyme-A. METHODS: From June 2005 to December 2005, 130 curative abdominal surgery, which were divided into a dexpanthenol group with 65 patients and a control group with 65 patients, were prospectively and randomly studied for recovery of bowel motility. RESULTS: No significant difference was found between the two groups as to incidence of postoperative ileus (16.9% vs. 15.4%, P=0.081), the time to flatus (77.2+/-38.4 vs. 77.9+/-31.9 hours, P=0.90), the time to defecation (5.3+/-2.7 vs. 5.1+/-2.6 days, P=0.77), the time to resumption of meals (7.9+/-4.0 vs. 8.9+/-4.2 days, P=0.17), and the duration of hospital stay (16.4+/-7.8 vs. 17.9+/-11.5 days, P=0.39). CONSLUSIONS: Since no differences in the postoperative bowel motility were observed between the two groups, dexpanthenol is not recommended for general surgical use.

Effects of Several Kampo Medicines on Postoperative Ileus Model / 日本東洋医学雑誌

The effects of four Kampo medicines, Ninjin-to, Hange-shashin-to, Rikkunshi-to and Sho-hange-ka-bukuryo-to, were investigated in a rat model of postoperative ileus. The postoperative ileus model was made by incising the abdomen and exposing the small intestine and caecum for five minutes under ether anesthesia. The gastrointestinal transit was estimated by the migration of a charcoal marker. In contrast to the animals anesthetized only, the gastrointestinal transit was markedly decreased in control animals. First, we studied the gastrointestinal prokinetic drugs (cisapride, mosapride and metoclopramide), the anti-inflammatory drug indomethacin, and the Kampo medicine Dai-kenchu-to in this model. They significantly increased the transit as compared with the control. Using the same method, Rikkunshi-to and Sho-hange-ka-bukuryo-to were demon-strated to be almost inactive. However, Ninjin-to and Hange-shashin-to not only significantly improved the gastrointestinal mobility compared to the control, but also showed stronger effects than those of Dai-kenchu-to. These results suggest that in addition to Dai-kenchu-to, Ninjin-to and Hange-shashin-to are also effective Kampo medicines for postoperative ileus.

Effect on Bowel Motility of Using Postoperative Epidural Analgesia with Fentanyl and Bupivacaine

BACKGROUND: As a means of producing pain relief after abdominal surgery, epidural opioids have been used postoperatively, but the results for return of bowel movements are ambiguous. Gastrointestinal side effects still constitute a major drawback in both acute and chronic use of opioids. This study was undertaken to compare the effects of epidural analgesia with those of intermittent injections of analgesics on postoperative bowel motility in patients who underwent abdominal surgery. METHODS: The epidural group (n=29) received continuous epidural analgesia with bupivacaine and fentanyl postoperatively for 3 days, and the control group (n=22) received intermittent injections of analgesics (Ketoprofen 100 mg/IM/day for 3 days). RESULTS: Patients in the epidural and the control groups were similar in sex, age, and operative method. The incidence of preoperative hypoalbuminemia (less than 3.5 g/dl) and hypokalemia (less than 3.5 mmol/L) was similar in both groups. The duration of preoperative hospital stay was 6.3 days in the epidural group and 5.9 days in the control group. The epidural group showed analgesic effect superior to those of the control group. After colectomy, the time from surgery until the first passage of flatus (3.8+/-1.7 days) and feces (4.9+/-2.2 days), and the time until intake of the first postoperative meal (5.9+/-1.6 days) were similar for both control group. CONCLUSIONS: There were no differences in the postoperative bowel movement between the two groups. Epidural analgesia with local anesthetics and opioids can be used to relieve postoperative pain without prolonging the postoperative ileus.