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 .
A randomised controlled trial of early initiation of oral feeding after caesarean delivery in Mulago Hospital.
BACKGROUND The concept of early initiation of oral feeding after caesarean delivery is well tolerated by patients , yet not routinely practice d in Mulago Hospital . An effective postoperative dietary management schedule could have major implication s on the management of maternal post-caesarean section mothers . OBJECTIVES To compare the effect of time initiation of oral feeding on acceptability , benefits and gastrointestinal functions in women who had undergone caesarean section in Mulago Hospital . DESIGN A r and omised controlled study . SETTING Mulago Hospital . SUBJECTS One hundred and ninety two women admitted on the postnatal ward after emergency or elective caesarean section for various indications and who satisfied the eligibility criteria were recruited and r and omized into the study . Assignment to the early feeding group or routine feeding group was done r and omly using a computer generated numbers . The early feeding group were encouraged to take sips of water within six to eight hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post operative under supervision . The routine group were managed by restricting oral intake for twenty four hours and administration of orals sips of water 24 to 48 hours post operative . The outcome measures were rate of ileus symptoms , post operative presence of bowel sounds , maternal pyrexia and acceptability and benefits of early feeding . RESULTS The mean age , parity and gravidity were similar in the two groups . The study shows that women of the early feeding group had more rapid return of their bowel function with significant more shorter mean post operative time intervals to bowels sounds ( 24.2 hours versus 34.2 hours ) , passage of flatus ( 51.6 hours versus 62.1 hours ) and bowel movement ( 67.8 hours versus 75.8 hours ) . The women who fed early , made more rapid recovery and expressed their interest in earlier hospital discharge . The findings significantly indicated that women in the early feeding group got out of bed ( patient mobilisation ) earlier ( p = 0.001 ) than their control group ( 15.1 hours versus 17.8 hours ) . This could probably have been because of the adequate rehydration and improved early energy intake . In comparison those who were fed early required less number of bottles of intravenous fluids ( 5.0 bottles versus 7.0 bottles ) . The average hospital stay was similar and not statistically significant in both groups ( 5.5 days versus 6.0 days ) . CONCLUSION Early initiation of oral feeding after caesarean delivery is safe and well tolerated and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus
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 .