Epidural anesthesia and analgesia. Their role in postoperative outcome.

Background

Postoperative ileus has traditionally been accepted as a normal response to tissue injury. No data support any beneficial effect of ileus and indeed it may contribute to delayed recovery and prolonged hospital stay. Efforts should, therefore, be made to reduce such ileus.



Methods

Material was identified from a Medline search of the literature, previous review articles and references cited in original papers. This paper updates knowledge on the pathophysiology and treatment of postoperative ileus.



Results and conclusion

Pathogenesis mainly involves inhibitory neural reflexes and inflammatory mediators released from the site of injury. The most effective method of reducing ileus is thoracic epidural blockade with local anaesthetic. Opioid-sparing analgesic techniques and non-steroidal anti-inflammatory agents also reduce ileus, as does laparoscopic surgery. Of the prokinetic agents only cisapride is proven beneficial; the effect of early enteral feeding remains unclear. However, postoperative ileus may be greatly reduced when all of the above are combined in a multimodal rehabilitation strategy. © 2000 British Journal of Surgery Society Ltd

Postoperative ileus: a preventable event

BackgroundChoice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colonic surgery.

Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery

Postoperative ileus is a concern among surgical patients.Epidural anesthesia and analgesia with local anesthetics can decrease the duration of ileus. Significant systemic absorption of local anesthesia occurs during epidural use. In this study, we examined whether many of the beneficial effects on b

Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy

Background The prevalence of exercise-induced gastrointestinal (GI) symptoms has been reported up to 70%. The pathophysiology largely remains unknown. Aim To review the physiological and pathophysiological changes of the GI-tract during physical exercise and the management of the most common gastrointestinal symptoms. Methods Search of the literature published in the English and Dutch languages using the Pubmed database to review the literature that focused on the relation between splanchnic blood flow (SBF), development of ischaemia, postischaemic endotoxinemia and motility. Results During physical exercise, the increased activity of the sympathetic nervous system (SNS) redistributes blood flow from the splanchnic organs to the working muscles. With prolonged duration and/or intensity, the SBF may be decreased by 80% or more. Most studies point in the direction of increased SNS-activity as central driving force for reduction in SBF. A severely reduced SBF may frequently cause GI ischaemia. GI-ischaemia combined with reduced vagal activity probably triggers changes in GI-motility and GI absorption derangements. GI-symptoms during physical exercise may be prevented by lowering the exercise intensity, preventing dehydration and avoiding the ingestion of hypertonic fluids. Conclusions Literature on the pathophysiology of exercise-induced GI-symptoms is scarce. Increased sympathetic nervous system activity and decreased splanchnic blood flow during physical exercise seems to be the key factor in the pathogenesis of exercise-induced GI-symptoms, and this should be the target for symptom reduction.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2036.2011.04980.x

Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow

Background:Intestinal ischemia is associated with derangement of gastrointestinal motility. Uncontrolled clinical observations that bupivacaine injected into the epidural space causes faster recovery of bowel motility after various abdominal operations led us to assess the hypothesis that epidural a

Epidural anesthesia accelerates the recovery of postischemic bowel motility in the rat.

An inverse correlation between postischemic gastrointestinal motility and the length of intestinal ischemia was found in an animal model. Intestinal ischemia was caused without concurrent laparotomy and for a predetermined time period (ischemia time) by pulling on an external nylon thread that was threaded through a double-lumen catheter. This catheter was passed into the abdominal cavity to encircle the superior mesenteric artery. Gastrointestinal motility was determined by the introduction of a color-marked meal into the animal's stomach and the measurement of the proportionate length of the small bowel filled with it (transit index). This simple and reliable animal model can also be used for the evaluation of techniques and pharmacological manipulations aimed at modulation of the effects of intestinal ischemia on intestinal motility and its consequences.

Postischemic intestinal motility in rat is inversely correlated to length of ischemia

OPIOIDS are known to reduce the motility of both the colon and the small intestine. However, some investigators have reported, both in animal models and in humans, that morphine increases duodenal motility. In vivo studies of the effect of morphine on small bowel motility are complicated because most have been performed in the postoperative period, where the additional trauma of laparotomy and bowel manipulation had already affected bowel motility. Previous studies have reported that intestinal ischemia also causes prolonged inhibition of bowel motility. The effect of morphine on intestinal motility has not been well assessed in situations in which ischemic injury to the bowel occurs without concurrent surgical injury. Recently, Zhang et al. reported that in a rat model of intestinal ischemia and reperfusion, pretreatment with morphine before ischemia and reperfusion markedly attenuated intestinal injury. The aim of the current study was to evaluate the effect of morphine on small bowel propulsion activity in a rat model in which controlled bowel ischemia was caused without concurrent abdominal surgery.

Effect of morphine on small bowel propulsion after intestinal ischemia.

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Epidural anesthesia accelerates the recovery of postischemic bowel motility in the rat.

Postischemic intestinal motility in rat is inversely correlated to length of ischemia

Effect of morphine on small bowel propulsion after intestinal ischemia.