The incidence and risk factors for post-operative ileus after spinal fusion surgery: a multivariate analysis.

PURPOSE: Post-operative ileus is a recognized complication of surgery. Little is known about the incidence and risk factors for post-operative ileus following spinal fusion surgery. To report the incidence and to assess for independent risk factors of post-operative ileus after spinal fusion surgery. METHODS: Retrospective single-centre cohort study. Patients with prolonged or recurrent post-operative ileus were identified by review of hospital stay documentation. Patients with post-operative ileus were matched 1:2 to a control cohort without post-operative ileus. Uni and multi variate analyses were performed on demographic, comorbidity, surgical indication, medication, and peri-operative details to identify risk factors for post-operative ileus. RESULTS: Two thousand six hundred and twenty five patients underwent spinal fusion surgery between January 2012 and December 2012. Forty nine patients with post-operative ileus were identified (1.9 %). Post-operative length of hospital stay was significantly longer for patients with post-operative ileus (9.3 ± 5.2 days), than control patients (5.5 ± 3.2 days) (p < 0.001). Independent risk factors were Lactated Ringers solution (aOR: 2.12, p < 0.001), 0.9 % NaCl solution (aOR: 2.82, p < 0.001), and intra-operative hydromorphone (aOR: 2.31, p < 0.01) and a history of gastro-oesophageal reflux (aOR: 4.86, p = 0.03). Albumin administration (aOR: 0.09, p < 0.01) was protective against post-operative ileus. CONCLUSIONS: Post-operative ileus is multifactorial in origin, and this study identified intra-operative hydromorphone and post-operative crystalloid fluid administration ≥2 litres as independent risk factors for the development of ileus.

Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery.

STUDY OBJECTIVE: To determine whether ultrasound guidance improves the quality of continuous popliteal block when compared with a nerve stimulator after major foot and ankle surgery. DESIGN: Prospective, randomized, double-blinded clinical trial. SETTING: Operating room, Postanesthesia Care Unit (PACU), and hospital wards of a university-affiliated hospital. PATIENTS: 45 ASA physical status 1, 2, and 3 patients undergoing elective major foot and ankle surgery. INTERVENTIONS: Placement of a popliteal sciactic nerve catheter using either nerve stimulator or ultrasound guidance. In the PACU, a continuous infusion of ropivacaine 0.2% was started at a basal rate of 4 mL/hr and adjusted in a standardized fashion to maintain visual analog scale (VAS) pain scores < 4. All patients also received intravenous (IV) patient-controlled analgesia with hydromorphone and oral opioids. MEASUREMENTS: VAS pain scores at rest and with physical therapy, ropivacaine use, opioid use, and opioid-related side effects were recorded. MAIN RESULTS: Cummulative ropivacaine use was lower in patients whose catheter was placed by ultrasound than by nerve stimulator guidance (mean 50 vs 197 mL, P < 0.001). Pain scores at rest and during activity were similar between groups. Cumulative opioid consumption (mean 858 vs 809 mg oral morphine equivalents) and daily frequencies of nausea (5% to 33% vs 0 to 24%) and pruritus (0 to 21% vs 0 to 24%) were similar between groups. Length of hospital stay was similar between groups (3.5 vs 3.7 days). CONCLUSIONS: Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups.