Introduction: Prospective study checkeing the prevalence of paralytic ileus after spinal operation in supine and prone operative position, and comparing the preventive effect of prophylactic gastrointestinal motility medication after spinal operation.

Methods: In single university hospital, all general anesthetic spinal patients with supine and prone operative position from March 2012 to November 2012 were included. The study period divided into 2 phase; first phase to analyze the prevalence of radiographic and symptomatic paralytic ileus after spinal operation (82 patients (24 cases with supine position and 58 cases with prone position) from March to July), and second phase to compare the therapeutic effect of prophylactic gastrointestinal motility medication for symptomatic paralytic ileus after spinal operation (66 patients (36 cases with prophylactic gastrointestinal motility medication(Buscopan® and Macperan®) and 30 cases with placebos (normal saline) from June to November).

Results: The basic demographic data including sex and age of the each subgroup were not different without meaningful values. In the first phase study to analyze the prevalence of paralytic ileus, 27 patients (32.9%) of radiographic paralytic ileus and 11 patients (13.4%) of symptomatic paralytic ileus were observed. The radiographic paralytic ileus was statistically significantly increased in prone positioned patients (p=0.044), but the symptomatic paralytic ileus was statistically not different between supine and prone positioned patients (p=0.385). In the second phase to compare the therapeutic effect of prophylactic gastrointestinal motility medication after spinal operation, the prophylactic medication was not useful to prevent the symptomatic paralytic ileus (11.1% (4/36) with prophylactic medication group and 16.7% (5/30) with placebo groups, p=0.513).

Conclusions: During the spinal operative, the prone position contributed the radiographic paralytic ileus, but not less contributed the symptomatic paralytic ileus. Unfortunately, the prophylactic motility medication for prevent symptomatic paralytic ileus is not useful in spine surgery.

Patient Care: The radiographic paralytic ileus and symptomatic paralytic ileus were observed 32.9% and 13.4% after spine operation. Although in this study showed the prophylactic motility medication was not useful, but prevent of this paralytic ileus is important to care to improve the postoperative life quality of patients and prevent the serious gastrointestinal complications.

Learning Objectives: The radiographic paralytic ileus was increased in prone positioned patients, but the symptomatic paralytic ileus was not different between supine and prone positioned patients. The prophylactic medication was not useful to prevent the symptomatic paralytic ileus, but this result could be interfered by multiple variants such as preoperative opioid medication, patient controlled analgesic after spine surgery, diabetes, smoking habit, alcohol consumption, obesity, diagnosis of spinal disease, and operation time could interfere the paralytic ileus after spinal surgery, although these were not evaluated in this study. So, a well-designed prospective study is needed to overcome these limitations.

References: J Spinal Disord 14:541-545, 2001 Spine (Phila Pa 1976) 14:1301-1307, 1989 J Healthc Qual 15:17-20, 1993 Int J Clin Pract 51:327-329, 1997 Can J Neurol Sci 27:77-78, 2000 World J Gastroenterol 11:4776-4781, 2005 Spine (Phila Pa 1976) 32:2232-2237, 2007 J Bone Joint Surg (Am) 79:1642-1647, 1997 Br J Surg 79:99-103, 1992 Can J Surg 42:133-137, 1999 Spine (Phila Pa 1976) 20:1592-1599, 1995 Surg Endosc 14:300-304, 2000 Drugs 62:2603-2615, 2002 J Neurosurg Spine 10:60-65, 2009 N Engl J Med 341:137-141, 1999 J Neurosurg Spine 10:578-584, 2009 Gastrointest Endosc Clin North Am 7:499-508, 1997 J Spinal Disord Tech 16:502-507, 2003 Am J Ther 14:561-566, 200