Epidural Anesthesia and Gastrointestinal Motility

Steinbrook, Richard A.

doi:10.1097/00000539-199804000-00029

Cited by 139 publications

(79 citation statements)

References 32 publications

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“…Nevertheless, a thoracic EDA remains a powerful adjunct and a central part of a multimodal strategy to improve postoperative surgical outcome [18]. Furthermore, among the important benefits of a functioning EDA is its positive effect on gut motility making early oral intake possible, potentially also because it reduces opiate requirements [17, 19, 20]. The benefits of a thoracic EDA are more pronounced when it is continued for 24–48 h after surgery [17], and the reduction of postoperative catabolism achieved by early enteral nutrition is believed to be partly or largely dependent on a functioning EDA [1].…”

Section: Discussionmentioning

confidence: 99%

Nutritional Support and Oral Intake after Gastric Resection in Five Northern European Countries

et al. 2005

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Background: A comprehensive evidence base for perioperative care in upper gastrointestinal (GI) surgery is lacking. Little is known about the routines currently practiced in the absence of such evidence. We describe postoperative practice after gastric resections in five northern European countries. Method and Setting: Questionnaire survey in all major digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results: 76% of all centres (n = 200/263) responded. Routines varied extensively both nationally and between countries. No uniformity was traced although a conservative trend was noticeable in the use of nasogastric decompression tubes and ‘nil-by-mouth’ regimens. Nutritional support during the first 5 days is generally offered in Denmark, but not in Scotland. Drinking at will is generally allowed in Denmark and Norway by the first postoperative day. Eating at will is uniformly restricted. Conclusion: The paucity of evidence is reflected by the marked heterogeneity in practice. Large groups of patients may be treated suboptimally. Best perioperative care for these patients must be defined and documented. Especially, the role of early oral intake at will in upper GI surgery needs to be clarified by sufficiently powered trials.

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Section: Discussionmentioning

confidence: 99%

Nutritional Support and Oral Intake after Gastric Resection in Five Northern European Countries

et al. 2005

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“…It has been hypothesized that epidural local anesthetics may decrease POI by blocking these afferent sympathetic inhibitory reflexes, as well as efferent sympathetics with a concomitant increase in splanchnic blood flow. Systemic absorption of local anesthetics may also have anti-inflammatory effects [7, 32, 33]. …”

Section: Poi: Prevention and Treatment Strategiesmentioning

confidence: 99%

A Comprehensive Review of Evidence-Based Strategies to Prevent and Treat Postoperative Ileus

2009

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Background: Postoperative ileus (POI) is a common complication of abdominal and several other surgeries leading to increased hospital stay and healthcare costs. POI also contributes towards numerous postsurgical comorbidities including deep vein thrombosis and pneumonia. POI is characterized by bowel distention and lack of bowel sounds, flatus and bowel movements. The causative mechanism is not fully understood and may be multifactorial including disorganized electrical activity, activation of inflammatory mediators and the use of opioid analgesics. Methods: A selective review of the literature pertaining to the prevention and treatment of adynamic ileus and POI was completed. More specifically we sought to evaluate RCTs, meta-analyses, consensus statements and articles providing graded evidence-based data on POI prevention and treatment. Results: Perioperative strategies employed to prevent or limit the duration of POI include avoidance of preoperative fasting and mechanical bowel preparation, use of epidural-local anesthetics, implementation of minimally-invasive surgical techniques, and modification of pain management strategies to limit opioid administration among others. Conclusion: Though many of these strategies have proven beneficial, no single approach has demonstrated the ability to prevent or treat POI. However, when these strategies are used in combination as part of a fast-track multimodal treatment plan, there is a significant decrease in time to return of normal bowel function and a shortened hospital stay. Additional studies are needed to make specific recommendations regarding which components of fast-track protocols are most beneficial.

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“…In einer direkten Dosis-WirkungsBeziehung beeinflussen Opioide die Ausbildung des POI weitgehend unabhängig von der Art der Applikation. Eine Alternative stellt der Einsatz thorakaler epiduraler Anästhesieverfahren dar, mit denen sich Opioide in der perioperativen Phase einsparen lassen und zusätzlich die intraoperative Aktivierung sympathischer Nervenfasern als weiterem wesentlichen Pathomechanismus des POI verringert wird [21,46]. Im Rahmen der epiduralen Anästhesie können sowohl Opioide als auch Lokalanästhetika verwendet werden, wobei zu beachten ist, dass Opioide auch bei dieser Verabreichungsform die Darmmotilität beeinträchtigen können.…”

Section: Epidurale Anäesthesieunclassified

Postoperative ileus

Köninger

Gutt

Mn³

et al. 2006

Chirurg

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Continuous improvements in surgical technique and anaesthesia for ileus have resulted in a significant reduction of perioperative complications. Postoperative outcome of surgical patients is increasingly dependent on the severity of postoperative ileus, which often determines morbidity and length of hospital stay. In the present article we discuss possible variables influencing this disease. Furthermore, means of prevention and therapeutic strategies for postoperative ileus are briefly presented.

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Epidural Anesthesia and Gastrointestinal Motility

Cited by 139 publications

References 32 publications

Nutritional Support and Oral Intake after Gastric Resection in Five Northern European Countries

Nutritional Support and Oral Intake after Gastric Resection in Five Northern European Countries

A Comprehensive Review of Evidence-Based Strategies to Prevent and Treat Postoperative Ileus

Postoperative ileus

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