Influence of Anesthetic Technique on Postoperative Oral Intake in Gynecological Surgery

Abstract

Background and Goal of Study: Since the introduction of the enhanced recovery after surgery (ERAS) protocol, many surgeons and anesthesiologists have shown an interest in postoperative early oral intake. Postoperative nausea, vomiting, and gastrointestinal hypomotility affect oral intake. Concurrently, these factors are also associated with anesthetic techniques. Therefore, we retrospectively investigated the influence of anesthetic technique on postoperative oral intake. Material(s) and Method(s): We enrolled consecutive patients who underwent gynecological surgery under general anesthesia with postoperative epidural anesthesia or intravenous patient controlled analgesia (IV-PCA) between January 2011 and December 2011. The patients received hospital meals after lunch on the first postoperative day (POD), in accordance with the postoperative management protocol employed in the gynecological department. Patients who underwent cesarean section and could not be adapted to the management protocol were excluded. In study A, we divided the patients into 2 groups: those receiving propofol (group T) and those receiving sevoflurane (group S). In study B, we divided the patients into 2 groups: those receiving postoperative epidural analgesia (group E) and those receiving IV-PCA (group P). Oral calorie intake and the incidences of nausea, vomiting, bowel sounds, and flatus were recorded on POD 0-3. P values less than 0.05 were considered significant. Results and Discussion: We enrolled 189 patients. In study A, the incidences of nausea and vomiting on POD 0 in group T (N = 93) were significantly lower than those in group S (N = 96) (20% vs. 36%, P = 0.01; 5% vs. 20%, P = 0.003). Oral calorie intake on POD 2 in group T was significantly higher than that in group S (1006 +/- 390 vs. 786 +/- 399 kcal/day, P = 0.0002). In study B, the incidences of nausea and vomiting on POD 0 and 1 in group E (N = 112) were significantly lower than those in group P (N = 77). The incidences of bowel sounds and flatus on POD 0 in group E were significantly higher than those in group P (65% vs. 42%, P = 0.001; 9% vs. 1%, P = 0.03). Conclusion(s): In comparison with sevoflurane, propofol significantly reduced nausea and vomiting on POD 0 in patients who had undergone gynecological surgery. Moreover, epidural analgesia significantly reduced nausea and vomiting on POD 0 and 1. Propofol and epidural anesthesia might contribute to early oral intake.