Management of opioid induced postoperative ileus: the current scenario

Abstract

Persistent postoperative ileus causes significant discomfort to a surgical patient. Not only it increases hospital stay or leads to rehospitalization, it involves significant cost of treatment and morbidity in some unfortunate patients. No single intervention, drug or perioperative protocol has been found to be successful. The strategy has to be multimodal. Early enteral feeds, active ambulation, physiotherapy, use of minimally invasive surgical techniques so as to reduce bowel handling, judicious use of narcotics, good perioperative pain relief using a multimodal approach are the strategies that when applied together has better outcomes. Peripherally acting opioid antagonists have been successfully used but are very costly. Perioperative intravenous lidocaine infusion along with other strategies appears promising.