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The effect of remote ischemic preconditioning on postoperative gastrointestinal function recovery in patients
Guo Yang1, Shuo Yang1, Shuran Lee1
1Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China.
Background:
Postoperative gastrointestinal dysfunction (PGD) is common after laparoscopic gynecological surgery, yet effective preventive interventions remain limited. Remote ischemic preconditioning (RIPC) elicits two distinct protective windows-an early phase at 1-3 h and a late phase at 24-72 h following ischemia-exerting anti‑inflammatory effects that persist for several days, but its role in gastrointestinal recovery after routine gynecological laparoscopy is unknown.
Purpose:
To investigate whether RIPC promotes postoperative gastrointestinal function recovery in patients undergoing gynecological laparoscopic surgery.
Methods:
This prospective, double‑blind, randomized controlled trial enrolled 210 female patients scheduled for elective gynecological laparoscopy. Patients were allocated 1:1:1 to three groups: Enhanced RIPC (true RIPC one day before surgery and again before anesthesia induction), Routine RIPC (sham intervention one day before surgery followed by true RIPC before induction), and Control (sham intervention both times). True RIPC consisted of three 5‑min cycles of 200 mmHg cuff inflation/deflation on the right lower limb; sham intervention used 60 mmHg inflation. The primary outcome was time to first postoperative flatus. Secondary outcomes included gastrointestinal function scores at 24 h and 48 h, inflammatory markers [neutrophil count (Neu), neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII)], VAS pain scores (rest and activity) at 24 h, 36 h, and 48 h and rescue analgesic/antiemetic events.
Results:
Baseline characteristics were similar across groups. Median time to first flatus was significantly shorter in the Enhanced group (23.71 h, IQR 20.48-28.04) compared with the Routine group (27.42 h, IQR 21.92-32.48) and Control group (31.00 h, IQR 28.31-38.88),all pairwise P < 0.05. At 24 h and 48 h, the Enhanced group had a significantly higher proportion of "good" gastrointestinal function scores than the Control group (P < 0.05). Postoperative increases in neutrophil count, NLR, SIRI, and SII were significantly attenuated in the Enhanced versus Control group (P < 0.05). Both resting and activity VAS scores were significantly lower in the Enhanced group at all time points (P < 0.05). No RIPC‑related adverse events were observed.
Conclusion:
RIPC significantly shortens time to first flatus and attenuates systemic inflammatory responses in patients undergoing gynecological laparoscopic surgery. However, the modest absolute reduction (approximately 7 h) and lack of effect on hospital stay suggest a limited clinical impact in the context of standard ERAS care. Further trials are needed to define its role, particularly in high‑risk populations.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR2500095141),2025-01-02.
