Effect of Peri-operative Intravenous Fluids on Recovery of Intestinal Function After Caesarean Delivery Under Spinal Anaesthesia At Kenyatta National Hospital

Abstract

Background: Ileus refers to the delay of regular bowel movement following intra-abdominal surgery and lasts 2 to 3 days. It is a major problem after operation that delays recovery. Several studies on adults have investigated the effect of “Liberal” versus “Restrictive” peri-operative fluid regimes on ileus after abdominal surgery in the non-obstetric population. Restrictive fluid regimen (<2700 mls) intra-operatively was found to be associated with enhanced intestinal recovery although data remains scanty in cesarean delivery. During caesarean delivery under spinal anaesthesia different regimes of intravenous fluids are used peri-operatively. Literature review revealed no studies conducted on their effect on intestinal recovery as well as no data on the incidence of post-operative ileus in the obstetric population. A study was necessary to determine the incidence ileus after surgery, the optimal peri-operative fluid regime for recovery of intestinal function after caesarean delivery (determined by time to tolerance first oral feed, time to flatus and time to defecation) and assist in developing a protocol for peri-operative intravenous fluids administration during caesarean delivery. Objective: The aim of this study was establish the effect of perioperative intravenous fluid volume on recovery of intestinal function after caesarean delivery under spinal anaesthesia. We also sought to find out the incidence of ileus postoperatively. Materials and Methods: This research was conducted as a prospective observational study after getting ethical approval from Kenyatta National Hospital – University of Nairobi Ethics and Research committee. 150 patients who delivered through caesarean section under spinal anaesthesia at KNH between March 2016 and May 2016 were recruited using consecutive sampling technique and followed up from admission into theatre up to 3 days post operatively in the postnatal wards. Intravenous fluids administered preoperatively, intra-operatively and post-operatively were documented and their effect on intestinal recovery post-operatively was evaluated. The outcomes of interest for recovery of intestinal function were time to first normal bowel sounds, time to tolerance of the first solid food, time to first flatus and time to defecation. Collected data was analysed using SPSS version 21. Descriptive statistics was used to determine prevalence of ileus after surgery. Regression analysis was undertaken to establish how various independent variables influence development of ileus postoperatively. A paired t-test, Pearson

correlation test and analysis of variance (ANOVA) was run to determine association between perioperative intravenous fluids and development of postoperative ileus. Results: Results from 150 patients were collected and analysed. Majority of patients (50%) were between 24 and 32 years, had BMI range of 26 to 32 and average parity was 3 to 5. Prevalence of ileus after caesarian delivery was 5.6%. The results of Pearson correlation test and ANOVA showed that preoperative intravenous fluids (normal saline 501 – 1000 ml) significantly influenced duration to first flatus (P=0.011), time to normal bowel rounds (P=0.029) and time to first oral feed(P=0.045). Conclusion: Prevalence of postoperative ileus in the obstetric population was established to be similar to that in abdominal surgery patients in studies conducted elsewhere. There is a significant association between pre-operative intravenous fluid administration and recovery of intestinal function postoperatively. We also noted that 501-1000mls of normal saline pre-operatively led to enhanced recovery of intestinal function compared to other fluid volumes. Intra-operative fluids were found to have no significant effect on gut recovery after operation. This study had the limitation of being an observational study. A larger randomized controlled study should be carried out to better understand the effect of immediate post-operative fluid volumes on recovery of intestinal functions.