Efficacy of Metoclopramide in Postoperative Ileus after Exploratory...
Efficacy of Metoclopramide in Postoperative Ileus after Exploratory...
Study Objective. To assess the efficacy of metoclopramide for treatment of postoperative ileus in patients who underwent exploratory laparatomy.
Design. Prospective observational study.
Setting. Surgical intensive care unit (SICU).
Patients. Thirty-two patients who underwent exploratory laparatomy.
Intervention. Sixteen patients received metoclopramide, and 16 did not. The primary outcome was time to first postoperative bowel movement. Secondary end points were length of stay (LOS) in the SICU and total hospital LOS.
Measurements and Main Results. The mean number of days to first bowel movement was nearly identical for both the treatment group and control group (4.8 vs 4.7 days, respectively, p=0.93). Length of stay in the SICU was 8.3 days for the treatment group and 8.6 days for the control group (p=0.89), and total LOS was 18.0 and 20.1 days, respectively (p=0.63).
Conclusion. The time to first bowel movement was not significantly different between the treatment and control groups. Also, metoclopramide did not decrease LOS. Metoclopramide does not have a role in the treatment of postoperative ileus.
Postoperative ileus is a poorly understood complication in postsurgical patients. In general, it is characterized as a temporary impairment of intestinal motility after surgery. Uncomplicated ileus occurs when areas of the gastrointestinal tract resume function at different times. The stomach can take 24-48 hours to recover, whereas the colon requires 48-72 hours to resume normal motility patterns. Thus, uncomplicated postoperative ileus resolves spontaneously after approximately 3 days.
Treatment of postoperative ileus is largely supportive, including nasogastric suction and intravenous hydration. Prokinetic agents are thought to be a possible treatment due to their ability to increase gastric motility. Metoclopramide antagonizes central and peripheral dopamine receptors and sensitizes gastrointestinal tract receptors to acetylcholine. These actions increase peristalsis in the antrum, duodenum, and jejunum and increase the lower esophageal pressure. However, the drug has no known effect on the colon. Metoclopramide also has antiemetic effects by suppressing dopamine receptors in the chemoreceptor trigger zone. Previous studies evaluating the efficacy of metoclopramide did not show any benefit in expediting recovery from postoperative ileus. Most of these studies used nonspecific end points such as flatus or bowel sounds to define recovery; however, bowel movement is the only definitive end point indicating resumption of gastrointestinal function. In addition, previous studies did not address the impact of metoclopramide on overall patient outcomes such as length of stay (LOS).
Study Objective. To assess the efficacy of metoclopramide for treatment of postoperative ileus in patients who underwent exploratory laparatomy.
Design. Prospective observational study.
Setting. Surgical intensive care unit (SICU).
Patients. Thirty-two patients who underwent exploratory laparatomy.
Intervention. Sixteen patients received metoclopramide, and 16 did not. The primary outcome was time to first postoperative bowel movement. Secondary end points were length of stay (LOS) in the SICU and total hospital LOS.
Measurements and Main Results. The mean number of days to first bowel movement was nearly identical for both the treatment group and control group (4.8 vs 4.7 days, respectively, p=0.93). Length of stay in the SICU was 8.3 days for the treatment group and 8.6 days for the control group (p=0.89), and total LOS was 18.0 and 20.1 days, respectively (p=0.63).
Conclusion. The time to first bowel movement was not significantly different between the treatment and control groups. Also, metoclopramide did not decrease LOS. Metoclopramide does not have a role in the treatment of postoperative ileus.
Postoperative ileus is a poorly understood complication in postsurgical patients. In general, it is characterized as a temporary impairment of intestinal motility after surgery. Uncomplicated ileus occurs when areas of the gastrointestinal tract resume function at different times. The stomach can take 24-48 hours to recover, whereas the colon requires 48-72 hours to resume normal motility patterns. Thus, uncomplicated postoperative ileus resolves spontaneously after approximately 3 days.
Treatment of postoperative ileus is largely supportive, including nasogastric suction and intravenous hydration. Prokinetic agents are thought to be a possible treatment due to their ability to increase gastric motility. Metoclopramide antagonizes central and peripheral dopamine receptors and sensitizes gastrointestinal tract receptors to acetylcholine. These actions increase peristalsis in the antrum, duodenum, and jejunum and increase the lower esophageal pressure. However, the drug has no known effect on the colon. Metoclopramide also has antiemetic effects by suppressing dopamine receptors in the chemoreceptor trigger zone. Previous studies evaluating the efficacy of metoclopramide did not show any benefit in expediting recovery from postoperative ileus. Most of these studies used nonspecific end points such as flatus or bowel sounds to define recovery; however, bowel movement is the only definitive end point indicating resumption of gastrointestinal function. In addition, previous studies did not address the impact of metoclopramide on overall patient outcomes such as length of stay (LOS).
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