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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.22792    [Epub ahead of print]
Published online April 25, 2023.
An increased total postoperative opiate dose is an independent risk factor for prolonged postoperative ileus after laparoscopic colorectal surgery: a case–control study
Hui Ju1, Kai Shen2, Jiaxin Li1, Yi Feng1
1Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
2Department of Gastroenterologic Surgery, Peking University People’s Hospital, Beijing, China
Corresponding author:  Yi Feng, Tel: 13601083503, 
Email: doctor_yifeng@sina.com
Received: 11 December 2022   • Revised: 20 March 2023   • Accepted: 24 April 2023
Prolonged postoperative ileus (PPOI) is a major complication after colorectal surgery. Increased consumption of opioid has been proposed to increase the risk of PPOI. This study tested the hypothesis that increased total postoperative opioid dose (TPOD) is associated with PPOI.
This is a matched case–control study. Patients who underwent elective laparoscopic colorectal procedures in Peking University People’s Hospital from January 2018 to June 2020 were retrospectively reviewed. Patients with PPOI were included in the ileus group. Meanwhile, patients without PPOI were matched (with a 1:1 ratio) as the control group according to age, American Society of Anesthesiology physical status, and type of surgical procedure.
A total of 267 individuals were eligible in the final analysis. There were no differences in baseline or operative factors between the two groups. TPOD, transversus abdominis plane (TAP) block, the intravenous sufentanil dose on postoperative day 1 (POD1), and using a patient-controlled analgesia (PCA) pump with a basal infusion were associated with PPOI (P < 0.05). Multivariate logistic regression analysis revealed that an increased TPOD was an independent risk factor for developing PPOI after the laparoscopic colorectal procedure (OR = 1.67, 95% CI = 1.03-2.71, P = 0.04).
The TPOD is an independent risk factor for developing PPOI after the laparoscopic colorectal procedure. Performing TAP block and using a PCA pump without a basal infusion might be promising strategies to reduce the TPOD.
Key Words: Opioid-induced bowl dysfunction; Ileus; Colorectal surgery; Case-control study; Postoperative pain; Nerve block
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