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

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.

Comparison of two surgical techniques: simple ligation and ligation with invagination of appendicular stump in appendicectomy for acute appendicitis

Appendicitis is an important differential diagnosis in patients with right lower quadrant pain. Acute appendicitis is the common emergency encountered round the globe. It is the cause of an acute surgical abdomen, and it remains one of the most challengeing diagnoses in the emergency department. Appendicectomy is the accepted therapy for acute appendicitis. To compare the technique of simple ligation and ligation with burial of the stump during appendicectomy for acute appendicits. Eighty cases of acute appendicitis were analysed for this study. They were randomly allocated to the two surgical procedures such as simple ligation [group I] and ligation with invagination [Group II] of appendicular stump in appendicectomy. The clinical variables were statistically evaluated. The frequency of postoperative ileus was more in group II [22.5%, and 5%] during first 48 and 72 hours respectively as compared to group I, p<0.05]. Postoperative wound infection was noticed in 15% patients in group I and 22.5% patients in group II [p>0.05]. Simple ligation of stump during appendicectomy is a better and safe procedure as compare to the invagination of stump because there is less incidence of postoperative complications such as postoperative paralytic ileus and wound infection