Nausea, vomiting and return of bowel function after colorectal surgery

Area of Science:

• Colorectal Surgery
• Enhanced Recovery After Surgery (ERAS) Protocols
• Post-Operative Care

Background:

• Enhanced Recovery After Surgery (ERAS) programs have established patterns for return of bowel function (ROBF) after colorectal surgery.
• Regular morphine use for analgesia is less common in ERAS protocols.
• This study investigates post-operative nausea and vomiting (PONV) and ROBF patterns in patients on ERAS programs receiving morphine.

Purpose of the Study:

• To describe the incidence and patterns of PONV in patients undergoing elective major colorectal surgery within an ERAS program.
• To delineate the patterns of ROBF in the same patient cohort.
• To explore the relationship between PONV, ROBF, and post-operative complications.

Main Methods:

• Retrospective analysis of 142 patients undergoing elective major colorectal surgery on an ERAS program over one year.
• Data collected included patient details, intra-operative course, post-operative management, outcomes, and complications.
• Statistical analysis was performed using Stata version 12.

Main Results:

• 96% of patients received morphine for post-operative analgesia.
• 79% experienced no or minimal PONV.
• ROBF was predictable: average flatus in 2.4 days and bowel opening in 4.3 days for patients without an ileostomy (shorter for those with an ileostomy).
• Vomiting was not significantly related to ROBF or overall complications.
• Wound complications, electrolyte abnormalities, and length of stay were associated with complications.

Conclusions:

• The majority of patients on ERAS colorectal surgery programs do not experience significant PONV.
• ROBF is generally predictable, allowing for timely interventions.
• These findings support confident early discharge decisions and aid in identifying patients with potential complications based on deviations from expected ROBF patterns.