Nausea, vomiting and return of bowel function after colorectal surgery.
BACKGROUND
Although patterns of return of bowel function (ROBF) following colorectal surgery with enhanced recovery after surgery (ERAS) programmes have been well delineated, regular morphine use is uncommon. This study describes the patterns of post-operative nausea and vomiting (PONV) and ROBF in this context.


METHODS
Patients undergoing elective major colorectal surgery on an ERAS programme over 1 year were included. Patient details, intra-operative course, post-operative management, outcomes and complications were collected retrospectively from clinical records. Statistical analysis was performed using Stata version 12.


RESULTS
A total of 136/142 (96%) patients received morphine for post-operative analgesia. Most (112/142, 79%) experienced either no vomiting (87/142, 61%) or small amounts (25/142, 18%). On average, patients without an ileostomy passed flatus and opened their bowels after 2.4 and 4.3 days, those with an ileostomy taking 1.5 and 2.1 days. Vomiting was not related to ROBF (P = 0.370) or overall complications; wound complications (odds ratio (OR) = 8.1, 95% confidence interval (CI): 2.0-32.5), electrolyte abnormalities (OR = 2.9, 95% CI: 1.2-7.1) and length of stay (hazard ratio = 1.3, 95% CI: 1.2-1.5) were related.


CONCLUSIONS
Most patients do not experience PONV in this context. ROBF is predictable without prolonged delays. This information could be used to allow confident early discharge and identify patients whose deviation from normal may indicate complications.
Department of General Surgery, Northern Health, Melbourne, Victoria, Australia.|Northern Clinical School, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Karen L
KL
Barclay
Northern Clinical School, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Ying-Yan
YY
Zhu
Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Mark A
MA
Tacey
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003106:Colon / Q000601:surgery; D003672:Defecation / Q000502:physiology*; D013505:Digestive System Surgical Procedures; D017558:Elective Surgical Procedures; D005260:Female; D005414:Flatulence / Q000503:physiopathology*; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D009020:Morphine
colorectal surgery; enhanced recovery after surgery; gastrointestinal function; general surgery; ileus; morphine; nausea and vomiting