Skip to main content

Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study

Abstract

The aim of this study was to determine the effectiveness of mechanical abdominal massage on postoperative pain and ileus after colectomy. We hypothesized that parietal abdominal stimulation could counteract induced pain and postoperative ileus, through common spinal-sensitive pathways, with nociceptive visceral messages. After preoperative randomization, 25 patients (age 52 ± 5 years) underwent active mechanical massage by intermittent negative pressure on the abdominal wall resulting in aspiration (Cellu M50 device, LPG, Valence, France), and 25 patients (age 60 ± 6 years) did not receive active mechanical massage (placebo group). Massage sessions began the first day after colectomy and were performed daily until the seventh postoperative day. In the active-massage group, amplitude and frequency were used, which have been shown to be effective in reducing muscular pain, whereas in the placebo group, ineffective parameters were used. Visual analogue scale (VAS) pain scores, doses of analgesics (propacetamol), and delay between surgery and the time to first passage of flatus were assessed. Types and dosages of the anesthetic drugs and the duration of the surgical procedure did not differ between groups. From the second and third postoperative days, respectively, VAS pain scores (P < 0.001) and doses of analgesics (P < 0.05) were significantly lower in patients receiving active massage compared to the placebo group. Time to first passage of flatus was also significantly shorter in the active-massage group (1.8 ± 0.3 days vs. 3.6 ± 0.4 days, P < 0.01). No adverse effects were observed. These results suggest that mechanical massage of the abdominal wall may decrease postoperative pain and ileus after colectomy.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990;35:121–132.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Kalff JC, Schraut WH, Simmons RL, Bauer AJ. Surgical manipulation of the gut elicits an intestinal muscularis in flammatory response resulting in paralytic ileus. Ann Surg 1998;228:652–663.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Kalff JC, Carlos TM, Schraut WH, et al. Surgically induced leukocytic infiltrates within the rat intestinal muscularis medi ate postoperative ileus. Gastroenterology 1999;117:378–387.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Kalff JC, Schraut WH, Billiar TR, et al. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 2000;118: 316–327.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Tache Y, Martinez V, Million M, Rivier J. Corticotrophin-releasing factor and the brain-gut motor response to stress. CanJ Gastroenterol 1999;13:18A-25A.

    Google Scholar 

  6. 6.

    Plourde V, Wong HC, Walsh JH, et al. CGRP antagonists and capsaicin on celiac ganglia partly prevent postoperative ileus. Peptides 1993;14:1225–1229.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    De Winter BY, Boeckxstaens GE, De Man JG, et al. Effect of adrenergic and nitrergic blockade on experimental ileus in rats. Br J Pharmacol 1997;120:464–468.

    PubMed  Article  Google Scholar 

  8. 8.

    Tanila H, Kauppila T, Taira T. Inhibition of intestinal motility and reversal of postlaparotomy ileus by selective alpha 2-adrenergic drugs in the rat. Gastroenterology 1993;104:819–824.

    PubMed  CAS  Google Scholar 

  9. 9.

    Riviere PJM, Pascaud X, Chevalier E, et al. Fedotozine re verses ileus induced by surgery and peritonitis: Action at pe ripheral kappa-opioid receptors. Gastroenterology 1993; 104: 724–731.

    PubMed  CAS  Google Scholar 

  10. 10.

    De Winter BY, Boeckxstaens GE, De Man JG, et al. Effects of mu- and kappa-opioid receptors on postoperative ileus in rats. Eur J Pharmacol 1997;339:63–67.

    PubMed  Article  Google Scholar 

  11. 11.

    Zittel TT, Lloyd KC, Rothenhofer I, et al. Calcitonin gene-related peptide and spinal afferents partly mediate postoper ative colonic ileus in the rat. Surgery 1998;123:518–527.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Freeman ME, Cheng G, Hocking MP. Role of alpha- and beta-calcitonin gene-related peptide in postoperative small bowel ileus. J Gastrointest Surg 1999;3:39–43.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Melzack R. Folk medicine and the sensory modulation of pain. In Wall PD, Melzack R, eds. Textbook of Pain, 3rd ed. Edinburgh: Churchill Livingstone, 1994, pp 1209–1217.

    Google Scholar 

  14. 14.

    Coffin B, Azpiroz F, Malagelada JR. Somatic stimulation reduces perception of gut distension in humans. Gastroen terology 1994;107:1636–1642.

    CAS  Google Scholar 

  15. 15.

    Field T, Peck M, Krugman S, et al. Burn injuries benefit from massage therapy. J Burn Care Rehabil 1998; 19:241–244.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Field T, Peck M, Hernandez-Reil M, et al. Postburn itch ing, pain, and psychological symptoms are reduced with massage therapy. J Burn Care Rehabil 2000;21:189–193.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Preyde M. Effectiveness of massage therapy for subacute low-back pain: A randomised controlled trial. Can Med Assoc J 2000;162:1815–1820.

    CAS  Google Scholar 

  18. 18.

    Hernandez-Reif M, Martinez A, Field T, et al. Premen strual symptoms are relieved by massage therapy. J Psychosom Obstet Gynecol 2000;21:9–15.

    CAS  Google Scholar 

  19. 19.

    Gavroy JP, Dinard J, Costagliola M, et al. LPG and cutane ous softening of burns. Plaies Cicatrisations 1996;5:42–46.

    Google Scholar 

  20. 20.

    Boeckstyns MEH, Backer M. Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 1989;38:29–33.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Roberts JP, Benson MJ, Rogers J, et al. Characterization of distal colonic motility in early postoperative period and effect of colonic anastomosis. Dig Dis Sci 1994;39:1961–1976.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Hamilton H. The assessment of anxiety status by rating. Br JMed Psychol 1959;32:50–55.

    CAS  Google Scholar 

  23. 10.

    Oliveira R, Prado WA. Anti-hypealgesic effect of electroa-cupuncture in a model of incisional pain in rats. Braz J Med Biol Res 2000;33:957–960.

    PubMed  CAS  Google Scholar 

  24. 24.

    Chen L, Tang J, White PF, et al. The effect of location of transcutaneous electrical nerve stimulation on postoperative opioid analgesic requirement: Acupoint versus nonacupoint stimulation. Anesth Analg 1998;87:1129–1134.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Makk LJK, Sagatelian MA, Wright RA. Effect of total body massage on irritable bowel syndrome: Results of a pilot study. Gastroenterology 1995;108:A644.

    Google Scholar 

  26. 26.

    Makk LJK, Williams B, Sagatelian M, et al.. The impact of total body massage and well being in patients with irritable bowel syndrome. Gastroenterology 1996;110:A712.

    Google Scholar 

  27. 27.

    Field T, Hernandez-Reif M, Taylor S, et al. Labor pain is reduced by massage therapy. J Psychosom Obstet Gynecol 1997;18:286–291.

    CAS  Article  Google Scholar 

  28. 28.

    Camilleri M, Malagelada JR, Kao PC, Zinsmeister AR. Ef fect of somatovisceral reflexes and selective dermatomal stimulation on post-cibal antral pressure activity. Am J Physiol 1984;247:G703-G708.

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Isabelle Le Blanc-Louvry M.D..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Le Blanc-Louvry, I., Costaglioli, B., Boulon, C. et al. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study. J Gastrointest Surg 6, 43–49 (2002). https://doi.org/10.1016/S1091-255X(01)00009-9

Download citation

Key words

  • Colectomy
  • postoperative ileus
  • mechanical massage