Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .
Early nasogastric tube removal combined with metoclopramide after radical cystectomy and urinary diversion.
PURPOSE Prolonged nasogastric decompression increases pulmonary complications by inhibiting clearance of respiratory secretions . The literature supports early nasogastric tube removal following bowel resection . Metoclopramide stimulates bowel activity , promoting return of function . We examined combining early nasogastric tube removal with metoclopramide after radical cystectomy . MATERIAL S AND METHODS From 1994 to 1996 , 27 prospect i ve cystectomy patients received intravenous metoclopramide ( metoclopramide group ) combined with early nasogastric tube removal ( less than 24 hours ) . A total of 54 concurrent cystectomy controls received no metoclopramide and nasogastric tubes remained until return of normal bowel function . RESULTS Preoperative and perioperative factors were comparable between the 2 groups .  Nasogastric tubes were removed from 78 % of the metoclopramide group in less than 24 hours , 11 % on day 2 and 11 % on day 3 compared to none on day 1 , 50 % on day 2 and 50 % on day 3 or greater in controls . The metoclopramide group had a more rapid return of normal bowel sounds ( 2.9 versus 4.0 days , p = 0.0002 ) and earlier tolerance of solid food ( 6.7 versus 7.9 days , p = 0.04 ) . Nasogastric tube replacement was required in 3 of 27 metoclopramide cases versus 5 of 54 controls . Atelectasis occurred more often in the control group ( 33 versus 15 % ) . There were no bowel related complications in the metoclopramide group but partial small bowel obstruction in 2 controls was treated conservatively . CONCLUSIONS This preliminary study suggests that combining intravenous metoclopramide with early nasogastric tube removal after cystectomy and urinary diversion may reduce postoperative atelectasis and speed return of bowel function while posing no danger to the small bowel anastomosis . This regimen may result in fewer complications and shorter hospitalizations , translating into lower costs without compromising quality of care
Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .