Multiple elements of the pathway may have an impact in supporting normal bowel function including laparoscopic surgery, fluid balance and opioid sparing analgesia. Chewing sugar free gum is a simple low cost intervention that decreases time to first flatus, bowel movement and hospital stay after colorectal surgery overall and reduces time to first BM when used as part of an ERP (1). Alvimopam accelerates the time to return of bowel function (tolerating solid food and passing flatus) after open colectomy when PCA analgesia is used (2).
For more information, see Chapter 12: Postoperative Ileus: Prevention and Treatment in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery
1. Short V, Herbert G, Perry R, Atkinson C, Ness AR, Penfold C, Thomas S, Andersen HK, Lewis SJ. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015 Feb 20;2:CD006506
2. Vaughan-Shaw PG1, Fecher IC, Harris S, Knight JS. A meta-analysis of the effectiveness of the opioid receptor antagonist alvimopan in reducing hospital length of stay and time to GI recovery in patients enrolled in a standardized accelerated recovery program after abdominal surgery. Dis Colon Rectum. 2012 May;55(5):611-20.