A 72-year-old woman undergoes an open sigmoid colectomy for colon cancer. Which of the following interventions reduces the incidence of postoperative ileus in this patient?

A. Methylnaltrexone
B. Sugar-free chewing gum
C. Wound infiltration with liposomal bupivacaine
D. Magnesium citrate
E. Bisacodyl suppositories

ANSWER: B

Enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery are derived from studies evaluating the efficacy of interventions designed to reduce the morbidity and cost of surgical procedures and
therefore improve outcomes and value.
One such intervention, providing sugar-free chewing gum perioperatively, is as a method of sham feeding, with the hope that the mastication motion will promote intestinal motility through the cephalic phase of vagal enteric stimulation.
The true mechanism is not entirely understood, and a randomized controlled trial of sugared chewing gum did not show abenefit, insinuating that the hexitols in sugar-free gum may
have a laxative effect and contribute to bowel motility. A meta-analysis summarizing the existing literature concluded that sugar-free chewing gum is an inexpensive and effective
way to reduce postoperative ileus, and it is well-tolerated without any detrimental effect on patient outcomes

Methylnaltrexone is currently indicated for opioid-induced constipation, but it was initially studied as an intervention to reduce postoperative ileus. Two large multicenter
randomized controlled trials failed to show a reduction in postoperative ileus compared with placebo. Liposomal bupivacaine is gaining in popularity as a component of multimodal pain control in ERAS protocols.
However, current data do not demonstrate superiority to conventional bupivacaine. Laxatives such as magnesium citrate and
stimulants such as bisacodyl will induce diarrhea, but they will not increase small intestinal motility or reduce postoperative ileus