Postoperative Ileus Management

Fluid Management and Nasogastric Decompression

The administration of intravenous isotonic fluids such as Ringer's lactate and normal saline is recommended when postoperative ileus is present, with moderate evidence supporting this strong recommendation 1
Nasogastric tube placement may be necessary in patients with severe abdominal distension, vomiting, or risk of aspiration 1
Intravenous rehydration should be continued until the patient's pulse, perfusion, and mental status normalize and there is no evidence of ileus 1

Thoracic epidural analgesia is highly effective in preventing postoperative ileus compared to intravenous opioid analgesia 1
Alvimopan, a μ-opioid receptor antagonist, can accelerate gastrointestinal recovery in postoperative ileus when opioid analgesia is being used 1
Chewing gum has been shown to have a positive effect on the duration of postoperative ileus 1, 2
Oral magnesium oxide may promote intestinal function in postoperative ileus 1

For the management of postoperative nausea and vomiting in patients without ileus, intraoperative anesthetic regimens associated with a lower incidence of nausea can be used along with perioperative antiemetics 3, 4
In cases of postoperative nausea and vomiting without ileus, a scheduled antiemetic regimen during the first 2 weeks can be considered 3, 4
Antiemetic agents should be used for the prevention and treatment of nausea and vomiting when indicated, but not in the presence of ileus 5

The use of opioids should be minimized as they can exacerbate ileus 6
Laparoscopic surgical approaches lead to a faster return of intestinal function compared to open surgery 1
Fluid overload during and after surgery should be avoided as it impairs gastrointestinal function 1