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Nonopioid analgesics shorten the duration of postoperative ileus
A A Ferraz1, V E Cowles, R E Condon
1Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
Abstract:
Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.
Insights
Ketorolac tromethamine, a nonsteroidal analgesic, speeds recovery from postoperative ileus by avoiding opioid-induced colon dysfunction. Morphine, an opioid, prolongs ileus by altering colon contractions.
Area of Science:
- Gastroenterology
- Pharmacology
- Surgical Recovery
Background:
- Opioids like morphine inhibit propulsive colon contractions, prolonging postoperative ileus.
- Nonsteroidal analgesics like ketorolac tromethamine do not affect colon contractions.
- Understanding the impact of analgesics on gastrointestinal motility is crucial for managing postoperative recovery.
Purpose of the Study:
- To compare the effects of ketorolac tromethamine versus morphine plus ketorolac on postoperative ileus resolution.
- To investigate the myoelectric activity of the colon in patients receiving different analgesic regimens.
Main Methods:
- Bipolar electrodes implanted on the right and left colon of 14 patients undergoing elective abdominal surgery.
- Myoelectric activity recorded for 5 days postoperatively, analyzing electrical control activity (ECA) and electrical response activity (ERA).
- Group A received ketorolac; Group B received ketorolac plus morphine for pain management.
Main Results:
- Faster resolution of postoperative ileus observed in patients receiving ketorolac alone compared to those receiving ketorolac plus morphine.
- A difference in the return of propagated long electrical response activity (ERA) bursts correlated with clinical recovery.
- Opioid administration was associated with motor abnormalities in the colon, delaying ileus resolution.
Conclusions:
- Postoperative analgesia with ketorolac tromethamine facilitates quicker recovery from ileus by preventing opioid-induced colon dysmotility.
- Avoiding opioids in the immediate postoperative period may improve gastrointestinal function and patient outcomes.
- Ketorolac tromethamine represents a viable option for managing postoperative pain without exacerbating ileus.