title: Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery.
abstract: OBJECTIVE
  A postoperative regimen using a multimodal approach with enforced mobilization and early oral nutrition has been reported to improve convalescence but has not been compared with other postoperative regimens.
  
  
  METHODS
  Forty patients undergoing elective colorectal surgery were randomly allocated to an intervention group receiving comprehensive information on the importance of mobilization, balanced anesthesia, and postoperative analgesia including epidural local anesthetics and enforced postoperative mobilization or a control group receiving anesthesia without epidural local anesthetics, postoperative analgesia with epidural morphine, and mobilization without fixed goals. All patients were offered early oral nutrition. The regimens were compared by means of ambulation time and physical activity, voluntary muscle strength, pulmonary function, and body composition.
  
  
  RESULTS
  The ambulation time improved substantially within 22 h in the intervention group versus 3 h in the control group on day 1 (P = 0.0004) and within 8 h versus 2 h on day 4 (P = 0.0003). The voluntary strength of the quadriceps muscle decreased by 3% in the intervention group versus 15% in the control group on day 7 (P = 0.04). Two months postoperatively, the difference between groups was the same (P = 0.02).
  
  
  CONCLUSIONS
  This active per- and postoperative regimen based on a multimodal approach improved ambulation time and muscle function during admission and late convalescence.
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus, Denmark. gaarden@dadlnet.dk
authors.forename: M G
authors.initials: MG
authors.lastname: Henriksen
authors.forename: M B
authors.initials: MB
authors.lastname: Jensen
authors.forename: H V
authors.initials: HV
authors.lastname: Hansen
authors.forename: T W
authors.initials: TW
authors.lastname: Jespersen
authors.forename: I
authors.initials: I
authors.lastname: Hessov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D003107:Colorectal Surgery; D003289:Convalescence; D004068:Digestive System Physiological Phenomena; D004434:Early Ambulation; D004435:Eating / Q000502:physiology*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D018482:Muscle, Skeletal / Q000502:physiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods*; D013997:Time Factors
chemical_list: D000700:Analgesics; D009020:Morphine; D002045:Bupivacaine