Acupuncture to Prevent Prolonged Postoperative Ileus: A Randomized Controlled Trial

Background: Prolonged postoperative ileus (PPI) is the inability to tolerate an oral diet, pass flatus, or have a bowel movement after postoperative day 3. Acupuncture has been used to treat gastrointestinal problems. Objective: To determine if acupuncture is effective in preventing PPI among cancer patients undergoing ileostomy/colostomy closure. Design, Setting, and Patients: Randomized clinical trial comparing bowel function, quality of life, and cost between inpatients treated with acupuncture after surgery and controls (no acupuncture). Participants (n = 78) were recruited from the Department of Surgical Oncology at the University of Texas M. D. Anderson Cancer Center between September 2003 and March 2006. All participants completed follow-up. Intervention: Patients in the treatment group (n = 38) received acupuncture twice a day, starting on postoperative day 1, for up to 4 consecutive days. Main Outcome Measures: Outcomes measured included bowel function, pain, use of opioid analgesics, nausea, vomiting, insomnia, abdominal distension/fullness, activity, and sense of well-being. Participants taking low-molecular-weight heparin were evaluated for bleeding. Results: The mean (SD) hours to first bowel movement were 59 (22) in the acupuncture group and 59 (26) in the control group. Opioid (mg) use was similar between the groups on the day of surgery (P = 0.25), and from postoperative day 1 until the first bowel movement (P = 0.32). Based on a 0-10 scale, general well-being was rated as 3.5 (1.2) in the acupuncture group and 3.6 (1.7) in the control group. The mean (SD) total number of hospital days was 5.1 (5.4) in the acupuncture group and 4.5 (2.5) in the control group. Only 4 patients developed PPI (1 treatment and 3 controls) during the entire study period. No significant differences were found between the groups; however, too few patients in this population developed PPI to make statistical analysis relevant. No one taking heparin in the acupuncture group had excessive bleeding after treatment. Conclusions: Acupuncture did not produce significantly better results. Future studies should evaluate acupuncture to prevent PPI in a different population.