Yonsei Med J.  2015 Nov;56(6):1627-1631. 10.3349/ymj.2015.56.6.1627.

Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation

• Oh CH
• Ji GY
• Yoon SH
• Hyun D
• Park HC
• Kim YJ

• KMID: 2345892
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1627

Abstract

PURPOSE
To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation.
MATERIALS AND METHODS
All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation.
RESULTS
Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513].
CONCLUSION
Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.

Keyword

Spine surgery; position; prone; supine; paralytic ileus

MeSH Terms

Adjuvants, Anesthesia/*administration & dosage/pharmacology
Adult
Aged
Antiemetics/*administration & dosage/pharmacology
Female
Gastrointestinal Motility/*drug effects/physiology
Humans
Injections, Intravenous
Intestinal Pseudo-Obstruction/drug therapy/epidemiology/*prevention & control
Lumbar Vertebrae/radiography/*surgery
Male
Metoclopramide/*administration & dosage/pharmacology
Middle Aged
Postoperative Complications/epidemiology
Prevalence
Prone Position
Prospective Studies
Republic of Korea
Scopolamine Hydrobromide/*administration & dosage/*pharmacology
Spinal Fusion/*adverse effects
Supine Position
Treatment Outcome
Adjuvants, Anesthesia
Antiemetics
Metoclopramide
Scopolamine Hydrobromide

Figure

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  Fig. 1 Paralytic ileus after thoracolumbar fusion operation within postoperative 2 days.

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