Clinical impact of a multimodal pain management protocol for loop ileostomy reversal

Purpose: As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy. Methods: Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B). Results: Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6±1.3 vs. 3.2±1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7±9.5 vs. 21.2±8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3±1.5 days vs. 4.1±1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate. Conclusion: Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.