Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients - A prospective, randomized, double-blind study

J. Y. Chen, G. J. Wu, M. S. Mok, Y. H. Chou, W. Z. Sun, P. L. Chen, W. S. Chan, H. W. Yien, Yeong Ray Wen

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Postoperative ileus (PI) is the transient impairment of bowel motility due to surgical trauma and the associated physiological responses. Postoperative ileus results in patient discomfort, increases gastrointestinal risks, prolongs hospital stay and increases medical expenses. In this study, we investigated the effect of patient-controlled analgesia (PCA) morphine with or without ketorolac on bowel functions in patients after colorectal surgeries. Methods: A total of 79 patients who received elective colorectal resection were randomly allocated into two groups receiving either intravenous PCA morphine (M group) or intravenous PCA morphine plus ketorolac (K group). Recovery of bowel functions (bowel movement, passage of flatus, and soft diet intake), pain scores, morphine consumption, time for first ambulation, and opioid-related side-effects were recorded. Results: Patients in the K group received 29% less morphine than patients in the M group with comparable pain scores. The first bowel movement (1.5 [0.7-1.9] vs. 1.7 [1.0-2.8] days, P <0.05) and the first ambulation (2.2 ± 1.0 vs. 2.8 ± 1.2 days, P <0.05) were significantly earlier in the K group than in the M group. The time of the first flatus passing, the first intake of soft diet, and duration of hospital stay were not significantly different between the two groups. Conclusions: The results of this study suggest that addition of ketorolac to intravenous morphine PCA provides an opioid-sparing effect but has limited benefit in shortening the duration of bowel immobility and time to first ambulation. These findings imply that postoperative ileus is attributable to multiple factors in addition to morphine consumption.

Original languageEnglish
Pages (from-to)546-551
Number of pages6
JournalActa Anaesthesiologica Scandinavica
Volume49
Issue number4
DOIs
Publication statusPublished - Apr 2005
Externally publishedYes

Fingerprint

Ketorolac
Patient-Controlled Analgesia
Colorectal Surgery
Double-Blind Method
Morphine
Ileus
Walking
Flatulence
Opioid Analgesics
Length of Stay
Diet
Pain
Recovery of Function
Wounds and Injuries

Keywords

  • Bowel movement
  • Ketorolac
  • Opioids
  • Patient-controlled analgesia
  • Postoperative ileus
  • Postoperative pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients - A prospective, randomized, double-blind study. / Chen, J. Y.; Wu, G. J.; Mok, M. S.; Chou, Y. H.; Sun, W. Z.; Chen, P. L.; Chan, W. S.; Yien, H. W.; Wen, Yeong Ray.

In: Acta Anaesthesiologica Scandinavica, Vol. 49, No. 4, 04.2005, p. 546-551.

Research output: Contribution to journalArticle

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abstract = "Background: Postoperative ileus (PI) is the transient impairment of bowel motility due to surgical trauma and the associated physiological responses. Postoperative ileus results in patient discomfort, increases gastrointestinal risks, prolongs hospital stay and increases medical expenses. In this study, we investigated the effect of patient-controlled analgesia (PCA) morphine with or without ketorolac on bowel functions in patients after colorectal surgeries. Methods: A total of 79 patients who received elective colorectal resection were randomly allocated into two groups receiving either intravenous PCA morphine (M group) or intravenous PCA morphine plus ketorolac (K group). Recovery of bowel functions (bowel movement, passage of flatus, and soft diet intake), pain scores, morphine consumption, time for first ambulation, and opioid-related side-effects were recorded. Results: Patients in the K group received 29{\%} less morphine than patients in the M group with comparable pain scores. The first bowel movement (1.5 [0.7-1.9] vs. 1.7 [1.0-2.8] days, P <0.05) and the first ambulation (2.2 ± 1.0 vs. 2.8 ± 1.2 days, P <0.05) were significantly earlier in the K group than in the M group. The time of the first flatus passing, the first intake of soft diet, and duration of hospital stay were not significantly different between the two groups. Conclusions: The results of this study suggest that addition of ketorolac to intravenous morphine PCA provides an opioid-sparing effect but has limited benefit in shortening the duration of bowel immobility and time to first ambulation. These findings imply that postoperative ileus is attributable to multiple factors in addition to morphine consumption.",
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AU - Wu, G. J.

AU - Mok, M. S.

AU - Chou, Y. H.

AU - Sun, W. Z.

AU - Chen, P. L.

AU - Chan, W. S.

AU - Yien, H. W.

AU - Wen, Yeong Ray

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