Epidural Anesthesia and Gastrointestinal Motility

作者：Richard A. Steinbrook · 发表于：Anesthesia & Analgesia · 年份：1998 · DOI：10.1213/00000539-199804000-00029 · 被引用次数：169 · 研究领域：Anesthesia and Pain Management、Cardiac, Anesthesia and Surgical Outcomes、Enhanced Recovery After Surgery

Postoperative ileus, a temporary inhibition of gastrointestinal function, is a universal complication after major abdominal surgery. Treatment for ileus is supportive and has changed little since Wangensteen's 1932 report [1] that nasogastric suction could delay or replace operative management of bowel obstruction, thereby reducing mortality. Gastric decompression, together with IV hydration and electrolyte replacement, remains the only proven therapy for ileus [2,3]. Liu et al. [4] suggest that epidural analgesia may significantly shorten the duration of postoperative ileus. The benefits of a reduction in ileus include decreased patient morbidity and potentially substantial cost-savings, as prolongation of hospitalization in the United States due to ileus has been estimated to cost $1,500 per patient or $750,000,000 annually [3]. Nevertheless, clinical guidelines currently promulgated by some consulting firms continue to state that "while epidural analgesia is effective for thoracic surgery and certain major musculoskeletal procedures, it has often been associated with prolonged ileus, delayed oral nutrition, and discharge in patients with gastrointestinal surgery" (Milliman and Robertson, Inc, Actuaries and Consultants, Seattle, WA, written communication, 1996). In this article, the pathophysiology of postoperative ileus is reviewed, and a framework for appreciating the theoretical basis for an effect of epidural anesthesia, especially thoracic epidural anesthesia, on ileus...