Yonsei Med J.  2014 Sep;55(5):1359-1365. 10.3349/ymj.2014.55.5.1359.

Analgesic Opioid Dose Is an Important Indicator of Postoperative Ileus Following Radical Cystectomy with Ileal Conduit: Experience in the Robotic Surgery Era

• Koo KC
• Yoon YE
• Chung BH
• Hong SJ
• Rha KH

• KMID: 1799503
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1359

Abstract

PURPOSE
Postoperative ileus (POI) is common following bowel resection for radical cystectomy with ileal conduit (RCIC). We investigated perioperative factors associated with prolonged POI following RCIC, with specific focus on opioid-based analgesic dosage.
MATERIALS AND METHODS
From March 2007 to January 2013, 78 open RCICs and 26 robot-assisted RCICs performed for bladder carcinoma were identified with adjustment for age, gender, American Society of Anesthesiologists grade, and body mass index (BMI). Perioperative records including operative time, intraoperative fluid excess, estimated blood loss, lymph node yield, and opioid analgesic dose were obtained to assess their associations with time to passage of flatus, tolerable oral diet, and length of hospital stay (LOS). Prior to general anaesthesia, patients received epidural patient-controlled analgesia (PCA) consisted of fentanyl with its dose adjusted for BMI. Postoperatively, single intravenous injections of tramadol were applied according to patient desire.
RESULTS
Multivariate analyses revealed cumulative dosages of both PCA fentanyl and tramadol injections as independent predictors of POI. According to surgical modality, linear regression analyses revealed cumulative dosages of PCA fentanyl and tramadol injections to be positively associated with time to first passage of flatus, tolerable diet, and LOS in the open RCIC group. In the robot-assisted RCIC group, only tramadol dose was associated with time to flatus and tolerable diet. Compared to open RCIC, robot-assisted RCIC yielded shorter days to diet and LOS; however, it failed to shorten days to first flatus.
CONCLUSION
Reducing opioid-based analgesics shortens the duration of POI. The utilization of the robotic system may confer additional benefit.

Keyword

Analgesics; opioid; cystectomy; ileus; robotics

MeSH Terms

Aged
Analgesics, Opioid/*administration & dosage/therapeutic use
Carcinoma/*surgery
Cystectomy/*adverse effects
Dose-Response Relationship, Drug
Female
Humans
Ileus/*epidemiology
Length of Stay
Linear Models
Male
Middle Aged
Multivariate Analysis
Robotic Surgical Procedures/adverse effects
Time Factors
Tramadol/*administration & dosage/therapeutic use
Treatment Outcome
Urinary Bladder Neoplasms/*surgery
Urinary Diversion/*adverse effects
Analgesics, Opioid
Tramadol

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