The risk of postoperative ileus can be reduced by certain interventions. Gannon recommended a multimodal approach that can minimize the occurrence and duration of ileus following surgery. The author is from the University of Connecticut.

Steps to reduce postoperative ileus - making choices:

(1) choice of operation - perform laparoscopy over laparotomy if at all possible

(2) choice of anesthesia -  thoracic epidural anesthesia with a local anesthetic such as lidocaine or bupivacaine, with the addition of an epidural opioid if additional pain control is needed

(3) choice of analgesia

(3a) minimize the use of opioids

(3b) use a systemic NSAID if possible to reduce the need for opioids

(3c) consider using a systemic opioid with the minimal effect on gastrointestinal smooth muscle, such as buprenorphine


Steps to reduce postoperative ileus - taking action:

(1) Keeping the infusion of intravenous fluids after surgery to a minimum.

(2) Removing the nasogastric tube soon after the surgery.

(3) Starting clear oral fluid intake on the first postoperative day.


Interventions not found to be effective:

(1) promotility agents (metoclopromide, erythromycin)

(2) chewing gum

(3) beta blockers

(4) laxatives

(5) neostigmine

(6) naloxone

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