Jul 2026· Supportive Care in Cancer· Vol 34· 0 citations· 17 references
Medicine
TL;DR
Adding MOM to ERAS was associated with reduced POI incidence and faster recovery of bowel function in patients undergoing abdominal hysterectomy for benign or malignant conditions.
Abstract
To evaluate whether adding milk of magnesia (MOM) to an enhanced recovery after surgery (ERAS) pathway prevents postoperative ileus (POI) and improves postoperative bowel function. This randomized controlled trial at the Gynecology Unit, Siriraj Hospital (Bangkok, Thailand) enrolled patients undergoing hysterectomy for benign or malignant indications during September 2023 through February 2024. Participants were randomly assigned to ERAS alone (n = 80) or ERAS plus MOM (n = 80). The MOM group received 15 mL on postoperative day 0 and then 30 mL twice daily until first flatus or bowel movement. The primary outcome was the time from surgery to resumption of a well-tolerated solid diet. Secondary outcomes included POI incidence, time to first flatus, patient-reported outcomes, and MOM-related complications. Among 160 patients, 60 (37.5%) had gynecologic malignancies: endometrial cancer (n = 34), ovarian cancer (n = 16), cervical cancer (n = 8), and leiomyosarcoma (n = 2). Time to well-tolerated solid diet was significantly shorter in the MOM group compared with the control group (20.6 ± 10.9 vs 28.8 ± 16.3 h; P < 0.001). The incidence of POI was also significantly lower (3.8% vs 27.5%; P < 0.001), and time to first flatus was shorter (17.1 ± 7.9 vs 22.3 ± 10.8 h; P < 0.001). Patient-reported outcomes favored the MOM group, with higher eating and daily activity satisfaction scores. No severe adverse events occurred in the MOM group. Adding MOM to ERAS was associated with reduced POI incidence and faster recovery of bowel function in patients undergoing abdominal hysterectomy for benign or malignant conditions. Thai Clinical Trials Registry (TCTR: TCTR20230816005), registered on 16 August 2023.
Early initiation of ONS combined with graded functional exercise following PD in patients with pancreatic neoplasms was associated with improved postoperative nutritional status, attenuation of skeletal muscle loss, and enhanced recovery of gastrointestinal and physical function, thereby supporting subsequent treatment.
Yuwen Chai, Renxuan Wang, Yaoyao Cai et al.· Nutrición Hospitalaria· 0 citations
Background: Shivering is an undesirable, and very common, postoperative event that causes a great deal of physiological stress. While several pharmacologic treatments are available, the efficacy of prophylactic (long-term) intravenous (IV) acetaminophen treatment has yet to be thoroughly studied. Objectives: To compare the effectiveness of prophylactic intravenous acetaminophen in preventing postoperative shivering in patients undergoing surgery under general anaesthesia. Methods: This was a randomized controlled trial that was carried out in the department of Anaesthesiology, Shalamar Hospital, a tertiary care hospital Lahore, from March 2026 to Jun 2026. 76 adult patients (ASA I/II) undergoing elective surgeries under general anesthesia were included. Participants were randomly assigned to either receive a 100 mL of normal saline with 1 g of IV acetaminophen over 15 minutes after induction (Group A, n = 38) or to receive a 100 mL of normal saline placebo for 15 minutes after induction (Group S, n = 38). We assessed shivering in the post anesthesia care unit using a standard 0–4 scale. Results: The incidence of postoperative shivering was significantly less in the acetaminophen group (13.2%) than in the placebo group (52.6%) (p < 0.001). In addition, Group A had a later start of shivering with a significant decrease in the number of anti-shivering rescue calls (p<0.05). Complication profiles did not differ significantly between the groups. Conclusions: IV acetaminophen administration during surgery can effectively reduce the incidence and intensity of postoperative shivering during general anesthesia, thereby improving the comfort of patients during surgery.
I. Khalid, Aamir Waseem, H. Babar et al.· Aposta: Revista de Ciencias...· 0 citations
BACKGROUND
Globally, the disease burden of colorectal cancer has been gradually increasing. Radical resection is the cornerstone treatment for colorectal cancer, but postoperative gastrointestinal dysfunction has been a potential complication. Current therapies are unsatisfactory. Acupuncture has the merits of inexpensive and easy-operative and has the potential to be a promising strategy.
OBJECTIVE
This study aimed to observe the effect and safety of electroacupuncture in facilitating the postoperative recovery of colorectal cancer patients.
DESIGN
Randomized controlled study.
SETTING
Prospective, single-center study.
PATIENTS
Patients over 18 years old who undergone radical resection of colorectal cancer.
INTERVENTIONS
Electroacupuncture or sham electroacupuncture at 2h after surgery and on the morning of the first 2 days after surgery, with 30 minutes each session.
OUTCOMES
The primary outcome was first flatus time. Secondary outcomes included first oral feeding time, bowel sound recovery time, length of postoperative hospitalization, adverse events, serum inflammatory cytokine indicators and heart rate variability indicators.
RESULTS
One hundred fifteen patients met the inclusion criteria and 101 patients completed the treatment and were enrolled into statistical analysis. There was no statistically significant difference (p > 0.05) in baselines. First flatus time, first oral feeding time, bowel sound recovery time were improved in electroacupuncture group (p < 0.05). Length of postoperative hospitalization was not significantly different. On postoperative day 1, interleukin-1β was lower in electroacupuncture group (p < 0.05); On postoperative day 3, interleukin -1 β, and interleukin -6 were lower in electroacupuncture group (p < 0.05). Percentage of difference between adjacent normal RR intervals exceeding 50ms and high frequency were higher in electroacupuncture group (p < 0.05). Kaplan-Meier curve analysis, multiple linear regression and correlation analysis secured the stability of the main results.
LIMITATIONS
This is a single-center trial with a small sample size and long-term follow-up was absent. No blank control group was set.
CONCLUSIONS
EA facilitated postoperative recovery without increasing the incidence of complications. This effect was hypothesized to be related to lower IL-1β/IL-6 levels and the rebalance of autonomic nervous system. See Video Abstract.Clinical trial registration: The trial has been registered at chictr.org.cn (ChiCTR2100050660 https://www.chictr.org.cn/hvshowproject.html?id=167502&v=1.9).
Haoyang Li, Yuling Cai, Ye Wang et al.· Diseases of the Colon & Rect...· 0 citations
Background Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in the perioperative management of gynecological conditions. However, the aggregate impact of ERAS on postoperative nausea and vomiting (PONV) following gynecological surgery remains incompletely characterized. Objective To evaluate the effectiveness of ERAS protocols in reducing PONV incidence among patients undergoing gynecological surgery. Methods This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 and MOOSE guidelines. A comprehensive literature search was performed across Web of Science, PubMed, Embase, and ScienceDirect from the inception of the databases up to April 2026. The Cochrane Risk of Bias 2 (RoB 2) tool was used for RCTs, and the Newcastle-Ottawa Scale (NOS) was used for cohort studies. The primary outcome was PONV incidence following gynecological surgery. Pooled effect estimates were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Robustness was assessed through sensitivity analysis. Publication bias was evaluated using funnel plots, Begg’s test, and Egger’s test. Results Eighteen studies (11 RCTs and 7 cohort studies), encompassing 3,275 patients and conducted between 2014 and 2026, were included. Fixed-effects meta-analysis demonstrated that ERAS significantly reduced PONV incidence compared with conventional care (OR = 0.48, 95% CI = 0.40 to 0.58, P < 0.001). Statistical heterogeneity was low (I2 = 29.8%, P = 0.114). Subgroup analysis revealed that the mean BMI was the possible source of heterogeneity (interaction P-value = 0.045). Neither influential studies nor significant publication bias were identified. Conclusion Implementation of ERAS protocols significantly reduces PONV following gynecological surgery. Widespread adoption of standardized ERAS pathways is essential to optimize postoperative recovery and alleviate the burden of PONV in this patient population. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359744, identifier CRD420261359744.
Background To compare the efficacy and incidence of adverse reactions of oliceridine versus sufentanil in patient-controlled intravenous analgesia (PCIA) for postoperative pain management following gynecological laparoscopic surgery. Methods In this randomized, double-blind trial, 152 patients undergoing elective gynecological laparoscopic surgery were randomly assigned to receive PCIA with either oliceridine (Group O, 0.4 mg/kg, n = 76) or sufentanil (Group S, 2 μg/kg, n = 76). The primary outcome was the Visual Analog Scale (VAS) score at rest at 2, 4, 8, 12, 18, 24, 36, and 48 h postoperatively. Secondary outcomes included postoperative Mini-Mental State Examination (MMSE) scores, number of PCIA demands, rescue analgesic use, adverse events, time to first flatus and defecation, patient satisfaction, and length of hospital stay. Results Resting VAS scores were comparable between groups except at 4 h (p < 0.05). No significant differences were observed in MMSE scores, PCIA demands, rescue analgesia, time to first defecation, or other adverse events (pruritus, dizziness, fever, headache, cough, and abdominal distension) (all p > 0.05). Group O had higher body weight and body mass index (BMI) than Group S (p = 0.028 and p = 0.041, respectively). Group O demonstrated lower postoperative nausea and vomiting (PONV) incidence (19.48% vs. 36.14%; relative risk (RR), 0.54; 95% confidence interval (CI), 0.32–0.92; p = 0.019), prolonged time to first flatus (27.16 ± 9.33 h vs. 23.23 ± 9.36 h; p = 0.014), and higher patient satisfaction (4.09 ± 0.81 vs. 3.74 ± 0.72; p = 0.006). Conclusion For postoperative analgesia following gynecological laparoscopic surgery, oliceridine provides effective analgesia comparable to sufentanil while significantly reducing the risk of opioid-related PONV, demonstrating a favorable safety profile. Clinical trial registration http://www.chictr.org.cn/, ChiCTR2400089648.
Jingmei Zhou, Zhuangbo Wu, Yuqing Lai et al.· Frontiers in Medicine· 0 citations
Background Optimizing anesthesia within the enhanced recovery after surgery (ERAS) protocol was crucial for elderly patients undergoing radical resection for colorectal cancer. This study aimed to assess the impact of remimazolam versus propofol anesthesia on postoperative gastrointestinal function recovery and complication rates in this population. Methods This prospective cohort study included elderly patients who underwent radical cancer resection from January 2023 to January 2025. Patients were assigned to either the remimazolam group or the propofol group based on the anesthetic used. Gastrointestinal hormones were measured preoperatively and 24 hours postoperatively. Recovery times for bowel sounds, first flatus, first defecation, and first solid food intake were recorded. Postoperative complications, including nausea/vomiting and delirium, were monitored, and recovery quality was assessed using the QoR-15 scale one week postoperatively. Results After propensity score matching, 243 patients were analyzed (remimazolam: n=115; propofol: n=128). At 24 hours postoperatively, motilin (81.47 ± 5.13 pg/mL vs. 79.61 ± 5.62 pg/mL, P = 0.008) and gastrin levels (48.25 ± 5.88 pg/mL vs. 42.72 ± 6.41 pg/mL) were higher in the remimazolam group. The remimazolam group showed shorter gastrointestinal recovery times (all P<0.05). Nausea/vomiting (5.22% vs. 13.28%, P = 0.032) and delirium (10.43% vs. 21.88%, P = 0.016) rates were lower, and QoR-15 scores were higher (125.44 ± 9.95 vs. 119.89 ± 12.82, P<0.001) compared to the propofol group. Conclusion For elderly patients undergoing colorectal cancer surgery within an ERAS pathway, remimazolam anesthesia was associated with shorter gastrointestinal recovery times, lower observed rates of selected postoperative complications, and higher QoR-15 scores compared with propofol. Given the prospective cohort design, these findings should be interpreted as associations rather than evidence of causality and require confirmation in randomized studies.
Yanming Xue, Jie Zhang· Frontiers in Oncology· 0 citations