Patient-controlled analgesia and prolonged ileus after uncomplicated colectomy

Because the duration of postoperative ileus after uncomplicated colon surgery has increased at our institution in the past 4 years, thereby prolonging length of hospital stay for some patients, we assessed several clinical factors to determine which were responsible for the increase.

We retrospectively studied a cohort of 358 patients who underwent uncomplicated colon resection to investigate risk factors for prolonged postoperative ileus. Postoperatively, all patients received an analgesic agent, delivered either intramuscularly (IM) or by patient-controlled analgesia (PCA) pump, until their postoperative ileus resolved, as indicated by the passage of flatus and tolerance of a clear liquid diet.

There was no significant relationship between the length of postoperative ileus patient age or gender, the operating time, or the type or amount of analgesic agent used postoperatively. A significantly larger proportion of the patients who received PCA than those given an IM agent had ileus at 7, 6, and 5 days after surgery (P < 0.0001 for all comparisons after controlling for confounding factors), however. Overall, the use of PCA was associated with a delay in return of normal bowel function of 0.9 days. Patients who underwent a right colectomy had a significantly shorter ileus than those who had other procedures.

Our findings indicate that the use of PCA after uncomplicated colectomy increases the risk of prolonged postoperative ileus. We suggest that the routine use of PCA after colon surgery be reevaluated.