A Randomized Control Trial on Efficacy of Gum Chewing in early Return of Bowel Function Among Patients Undergone Elective Abdominal Surgery at Selected Hospital, Ludhiana, Punjab

Aims and Objective: To assess the efficacy of bubble gum chewing in early return of bowel function among patients undergone elective abdominal surgery.

Background: Delay in early return of bowel functions (Paralytic ileus) is a common side effect of various types of surgical procedure results in constipation and bloating commonly known as postsurgical ileus. The main reason of impaired bowel function after abdominal surgeries include electrolyte imbalances, gastroenteritis, appendicitis, pancreatitis, surgical complications, and obstruction of the mesenteric artery, which supplies blood to the abdomen. Certain drugs and medications, such as opioids and sedatives, can cause ileus by slowing bowel peristalsis, the contractions that propel food through the digestive tract.<SUP>2</SUP> Conventionally, POI has been managed by gastric decompression by Ryle's tube, keeping the patient nil per orally, intravenous fluid supplementation till ileus resolves, and patient passes flatus. In recent years, the use of gum chewing has emerged as a new and simple modality for decreasing POI. It acts by stimulating intestinal motility through cephalic vagal reflex and by increasing the production of gastrointestinal hormones associated with bowel motility.

Design: A randomized, parallel control trial

Method: It was conducted in January 2014 in selected surgery recovery and surgery units at DMC&amp;Hospital, Ludhiana. Out of total 60 subjects, 30 in both experimental and control group were selected by convenience sampling technique. The tool consists of three parts:

* Section A: Socio-demographic sheet.

* Section B: Clinical profile sheet.

* Section C: Bowel movement assessment sheet.

* Section D: Bowel sound auscultation sheet.

Results: As seen first bowel sound heard by auscultation within 21.35±17.58 hours in experimental group which is less than control group i.e 24.96±21.91 hours. Time taken for first flatus passed and tolerance of oral feeds was also comparatively less in experimental group i.e. 37.91±24.40 and 61.62±39.06 respectively as compare to control group i.e. 42.68±27.64 and 73.93±60.69. In addition to it, post-Operative length of hospital stay (in days) was also shorter in experimental group 07.63±03.25 as compare to control group 09.43±5.01. On the other hand, time taken in case of first stool passed and return of appetite is more in experimental group (75.44±37.41 and 37.94±31.03) as compare of control group (69.72±34.75 and 34.16±34.78 respectively).

Conclusion: Although there is difference in mean time but there is no statistical significant difference found in return of bowel functions among experimental and control group.

Relevance to Clinical Practice:
1 Chewing gum can reduce the occurrence of postoperative paralytic ileus.
2 Nurses can use this therapy as a effective measure to prevent postoperative paralytic ileus.
3 Administration of chewing gum can provide mouth freshness to the postoperative clients.
4 Chewing gum can reduce the mental stress and provides relaxation to the post operative clients.
5 Chewing gum serves as a divertional activity too.