35 - Pain Management Following Colectomy: A Surgeon's Perspective  pp. 583-588

Pain Management Following Colectomy: A Surgeon's Perspective

By Theodore J. Saclarides

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Colectomy, whether performed for benign or malignant disease processes, is a potentially morbid operation accompanied by a significant hospital stay, prolonged period of recovery, and extended time off from work. There has been considerable interest recently in determining ways to lessen complications and hasten recovery. Several centers have established clinical pathways and fast-track protocols that attempt to streamline the care of these patients from the minute they walk into the admissions department to the time the discharge order is written. Integral to the optimum management of patients undergoing colon resection is efficient pain control. In fact, pain specialists, whether they are anesthesiologists, nurse anesthetists, or nurse clinicians, have become important team members in these pathway committees.

Successful relief of pain following major abdominal surgery invariably involves the use of parenteral and oral opioids; however, it is well known that narcotics contribute to the formation of an ileus, persistence of which may impair the recovery of patients with respect to restoration of normal bowel function. Consequently, clinicians have sought for ways to minimize the use of systemic narcotics, hasten recovery, and shorten hospital stay without compromising patient comfort or overall satisfaction with respect to their hospitalization. These efforts include neuraxial administration of opioids, using nonnarcotic analgesics, employing minimally invasive surgical techniques, and challenging traditional surgical practices with respect to nasogastric decompression, diet advancement, physical activity, and reliance on old criteria for discharge such as the passage of stool.