Management of Postoperative Ileus

Abstract

Postoperative ileus, a temporary cessation in bowel motility, is a common and significant complication of major surgery. Consequences of postoperative ileus include increased patient discomfort, delayed time to adequate nutrition, prolonged length of stay, and increased cost to the patient and healthcare system. The traditional, multi-modal approach to the resolution of postoperative ileus includes opioid minimization, early ambulation, and early feeding. Newer medications, such as methlynaltrexone and alvimopan (which are peripherally acting mu opioid receptor antagonists), have become available and have proven beneficial for use with postoperative ileus.

Physiology, signaling, and pharmacology of opioid receptors and their ligands in the gastrointestinal tract: current concepts and future perspectives

“…Opioid agonists, which are used for the treatment of post-operative pain, may negatively contribute to POI by stimulation of MOR in the GI tract and inhibition of intestinal motility [134], as well as activation of iNOS and increase in NO release from phagocytes. The major purpose of peripherally acting MOR antagonist (PAMORA) administration is the mitigation of adverse side effects of endogenous and exogenous opioids in periphery with maintenance of analgesic effect in the CNS, mainly due to a low BBB permeability at therapeutic concentrations (Fig.…”

Paralytic Ileus in the Orthopaedic Patient

“…Acetylcholine, neurokinin A, and substance P are stimulatory gastrointestinal neurotransmitters, whereas vasoactive intestinal peptide and nitrous oxide are inhibitory to gastrointestinal motility. 26 Opioid receptors play important roles in neurohormonal regulation throughout the central and enteric nervous systems. 16 Suppression of parasympathetic activity and hyperactivity of the sympathetic nervous system in the postoperative period as a result of pain may be contributory.…”

Role of tissue engineered collagen based tridimensional implant on the healing response of the experimentally induced large Achilles tendon defect model in rabbits: a long term study with high clinical relevance

“…If such a treatment is neglected, then joint stiffness is developed and the functionality, especially at ankle area, would be significantly impaired which complicates the condition [4,6-8]. However, treatment of large Achilles tendon defect is technically demanding and there is no well approved gold standard method for such a large soft tissue reconstruction [2,3,6]. In fact, variation in the surgical techniques for repairing a large Achilles tendon defect is remarkable and it is therefore difficult to determine the method of choice [4,8].…”

“…Many different surgical techniques exist, only a few of them have been validated in a strict scientific manner [6]. The v-y technique, local tissue augmentation, turn-down flaps, tendon transfer, free tissue transfer and the use of synthetic materials are some of examples, each have its own significant limitations [2-4]. Tendon transplantation could be potentially a method of choice however, due to the large size of the harvesting autograft, the donor site morbidity is a major concern and the allografts have not been widely accepted as yet, due to many reasons such as disease transmission (e.g.…”

“…Tendon transplantation could be potentially a method of choice however, due to the large size of the harvesting autograft, the donor site morbidity is a major concern and the allografts have not been widely accepted as yet, due to many reasons such as disease transmission (e.g. HIV), rejection and ethical concerns [1,2]. For these reasons, treatment of such massive tendon injuries, is a state of art and depends on the surgeon’s experience, equipment, facilitation, and condition [1,3].…”