Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty

Abstract

Aims and objectives:To evaluate the efficacy and safety of a comprehensive protocol for constipation prevention.Background: Constipation is a common problem for patients undergoing total hip arthroplasty (THA), yet sparse evidence is available to guide constipation prevention after THA. Design: Randomised controlled superiority clinical trial.Methods: This randomised controlled study was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). A total of 80 THA patients were randomised to receive only preoperative education about lifestyle or the combination of education with postoperative abdominal massage and polyethylene glycol 4,000 (Forlax®). Efficacy outcomes included rates of postoperative constipation and enema rescue, as well as time to first postoperative defecation and readmission within 30 days. Safety outcomes were number and type of adverse events.Results: Patients who received combination treatment showed a significantly lower rate of postoperative constipation during hospitalisation than patients who received only preoperative education (25% versus 55%), and they showed a significantly lower rate of enema rescue (12.5% versus 40%). Many more patients receiving combination treatment experienced their first defecation within two postoperative days than patients who received only preoperative education (62.5% versus 35.9%). In contrast, the two groups were similar in terms of constipation rate on postoperative days 15 and 30, rate of readmission within 30 days and rate of postoperative adverse events. Conclusions:These results suggest that our comprehensive protocol can relieve constipation after THA, reduce the need for enema rescue and shorten time to first defecation without sacrificing safety. More work is needed to optimise and develop this protocol further.Relevance to clinical practice: Constipation is a distressing problem that frequently occurs after THA. This study confirmed that a comprehensive protocol including preoperative education, postoperative abdominal massage and polyethylene glycol 4,000 can effectively relieve constipation after THA without sacrificing safety.

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort

“…It has previously been theorized that the implementation of enhanced recovery pathways may reduce the number of GI-complications [17], as several elements such as multimodal analgesia, early mobilization, only in-hospital thromboprophylaxis and reduced need of hospitalization may reduce the risks of GI-complications such as GIB and constipation [17][18][19] as demonstrated in our study. Thromboprophylaxis after THA and TKA surgery is a complicated task due to the opposite risks of VTE and GIB, which was the most common GI-complication in our cohort.…”

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Patients prescribed opioids should also receive scheduled stimulant bowel regimens to avoid opioid-induced constipation and progression to ileus, a risk that is heightened in the postoperative period (Table 10). Standard preventative use of a stimulant laxative such as senna or bisacodyl is generally effective in preventing opioid-induced constipation in opioid-naive patients, and available evidence does not suggest a superior agent [454][455][456][457][458]. The addition of stool softeners (i.e., docusate) and/or laxatives of alternative classes (e.g., osmotic agents like polyethylene glycol or magnesium oxide) may be added if needed postoperatively, but sugar-based strategies such as lactulose or sorbitol should be avoided due to adverse event risks [454,455].…”

Effect of Acupressure and Abdominal Massage on Constipation in Patients with Total Knee Arthroplasty: A Randomized Controlled Study

“…New methods and evidence are needed so that nurses can implement the information related to nonpharmacological therapies used in the treatment of constipation and provide high quality care. Acupressure and abdominal massage have been used and found to be effective in the treatment of constipation in the hospital environment after surgery (Seyyedrassoli et al, 2016; Turan and Aştı; 2016; Yue et al, 2020; Zhu et al, 2009).…”