- Design
- Prospective randomised controlled trial with cine-MRI motility assessment
- Population
- 130 patients undergoing laparoscopic radical gastrectomy (65 per group)
- Primary outcome
- Postoperative ileus and small-bowel motility
- Effect
- Ileus 9.2% vs 26.2%; risk ratio 0.35 (95% CI 0.15-0.84); risk difference -16.9 points
A randomised trial assigned 130 patients having laparoscopic radical gastrectomy to opioid-sparing multimodal analgesia or conventional opioid analgesia, assessing bowel recovery with cine-MRI of small-bowel motility.
Postoperative ileus occurred in 9.2% of the opioid-sparing group versus 26.2% with conventional opioids (risk ratio 0.35, 95% CI 0.15-0.84; risk difference -16.9 percentage points). The opioid-sparing group also showed better small-bowel contraction frequency and amplitude, lower opioid use and pain scores, and faster gastrointestinal recovery.
The result reinforces multimodal, opioid-sparing analgesia as a core element of enhanced recovery after gastrointestinal surgery: less opioid means a gut that wakes up sooner. It is a single-centre trial of modest size, so it strengthens rather than establishes the approach, and the cine-MRI motility measure is a research tool rather than routine care.
- Opioid-sparing analgesia cut postoperative ileus from 26.2% to 9.2% (risk ratio 0.35).
- Small-bowel motility on cine-MRI was better with less opioid.
- Opioid use, pain scores and recovery time all improved.
- Use multimodal opioid-sparing analgesia as part of enhanced recovery after GI surgery.
- This is a single-centre trial, so it supports rather than proves the strategy.
Why it matters
It ties a concrete postoperative outcome, ileus, directly to how much opioid is used.
Don't overread it
Single-centre trial of modest size; it supports opioid-sparing analgesia but does not by itself set a standard, and cine-MRI is a research measure.
The statistics, in plain English
A risk ratio of 0.35 means about a two-thirds relative reduction in ileus; the wide confidence interval reflects the modest sample, so the size is real but imprecise.
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