ESNG-MEDED.com: Evidence-based Management of Postoperative Ileus

Evidence-based Management of Postoperative Ileus

Issue 2

Preventing Postoperative Ileus: The Use of Epidural Analgesia and Opioid Antagonists to Ameliorate Adverse Effects

Ronald S. Chamberlain, MD, MPA, FACS (Chair)
Chairman, Department of Surgery and Surgeon in Chief
Saint Barnabas Medical Center, Livingston, NJ

James Rathmell, MD
Associate Professor of Anesthesia
Harvard Medical School, Boston, MA
Adjunct Professor of Anesthesiology
University of Vermont College of Medicine, Burlington, VT
Attending Physician in Anesthesiology and Pain Medicine
Director, Massachusetts General Hospital Pain Center, Boston, MA

The pathogenesis of postoperative ileus (POI) is multifactorial and includes the activation of inhibitory reflexes, inflammatory mediators, and endogenous and exogenous opioids. Various strategies have been employed, and currently are being investigated, to prevent POI. These include the use of epidural local anesthetics for postoperative analgesia, the use of anti-inflammatory nonsteroidal anti-inflammatory drugs and COX-2 inhibitors, and the development of new peripheral µ-opioid receptor antagonists such as methylnaltrexone and alvimopan. The use of these methods for preventing and treating POI is discussed.

To view the supplement, click the image above. To take the CME test, please go to CE-university.org. Requires Adobe Acrobat Reader.

Learning Objectives

After completing this activity, readers should be able to:

Compare the advantages and disadvantages of perioperative epidural and opioid analgesia in regard to POI
Summarize the mechanisms by which epidural local anesthetics are proposed to shorten the duration of POI and decrease time to discharge
Explain how nonsteroidal anti-inflammatory drugs and COX-2 inhibitors may act to aid in POI prevention
Assess how µ-opioid antagonists may help to prevent POI

Target Audience

This program is intended for the education of colon and rectal surgeons, general surgeons, medical/surgical nurses, and other health care providers involved in the management of POI.

Accreditation and Designation

The Chatham Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Chatham Institute designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The Chatham Institute LLC is an approved provider of continuing nursing education by the New Jersey State Nurses Association (NJSNA), an accredited approver by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation, provider number 175-11/2006-2009.

The Chatham Institute LLC is approved by the California Board of Registered Nursing (CBRN), provider number CEP 12433.

This activity is approved for 0.5 contact hours.

Disclaimer

Accreditation refers to educational content only and does not imply endorsement of products by NJSNA, ANCC, CBRN, or The Chatham Institute LLC.

Disclosure

It is the policy of The Chatham Institute to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. All faculty, planners, and managers who affect the content of medical education activities sponsored by The Chatham Institute are required to disclose to the audience any real or apparent conflict of interest related to the activity. Faculty, planners, and managers not complying with the disclosure policy will not be permitted to participate in this activity.

Ronald S. Chamberlain, MD, MPA, FACS (Chair): Speaker Bureaus: Ethicon, Inc., Pfizer Inc, sanofi-aventis U.S. LLC, Wyeth Pharmaceuticals
James Rathmell, MD: Contracted Research: Anesiva

Release Date:: January 2008
Expiration Date:: January 2009

This e-newsletter is available online at: http://www.ce-university.org/surgery