PATIENT-CONTROLLED ANALGESIA AND PROLONGED ILEUS AFTER UNCOMPLICATED COLECTOMY

BACKGROUND: Because the duration of postoperative ileus after uncompli cated colon surgery has increased at our institution in the past 4 yea rs, thereby prolonging length of hospital stay for some patients, we a ssessed several clinical factors to determine which were responsible f or the increase. PATIENTS AND METHODS: We retrospectively studied a co hort of 358 patients who underwent uncomplicated colon resection to in vestigate risk factors for prolonged postoperative ileus. Postoperativ ely, all patients received an analgesic agent, delivered either intram uscularly (IM) or by patient-controlled analgesia (PCA) pump, until th eir postoperative ileus resolved, as indicated by the passage of flatu s and tolerance of a clear liquid diet. RESULTS: There was no signific ant relationship between the length of postoperative ileus and 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 inn agent had ileus at 7 , 6, and 5 days after surgery (P <0.0001 for all comparisons after con trolling for confounding factors), however. Overall, the use of PCA wa s associated with a delay in return of normal bowel function of 0.9 da ys. Patients who underwent a right colectomy had a significantly short er ileus than those who had other procedures. CONCLUSIONS: Our finding s indicate that the use of PCA after uncomplicated colectomy increases the risk of prolonged postoperative ileus. We suggest that the routin e use of PCA after colon surgery be reevaluated.