Neurostimulation for the Treatment of Post-Operative Ileus

Inclusion Criteria:

• Male or Female, Age >18 years, < 65 years
• Partial small or large bowel open resection with primary anastomosis
• 120 hours post-operative with no signs of functional bowel activity
• Able to give Informed Consent

• By Post-Op Day 5, patient care has involved at least 3 of the following conservative therapies to minimize long term POI:

  i. post-operative, patient controlled opioid analgesia ii. removal of intra-operative nasogastric tube at time of surgery or on post-operative day 1 iii. advancement of liquid diet iv. advancement of solid food v. ambulation vi. use of chewing gum

Exclusion Criteria:

• Pregnant
• Undergoing surgery for repair of penetrating trauma injury, gangrene or ischemic bowel
• Evidence of anastomotic leak, abdominal infection, sepsis, bowel perforation, mechanical small bowel obstruction or metabolic derangement (e.g., low potassium/magnesium)
• Presence of existing implanted or external stimulator for pain or other indications (including pacemaker)
• Operative blood lost of > 500 cc
• Significant scarring of the skin along the lower thoracic/lumbar spine or deformation of thoracic spinal canal from congenital, developmental or traumatic causes, or previous extensive spinal thoracic surgery other than diskectomy
• Received a lumbar or thoracic epidural block placed immediately prior to surgery
• Body Mass Index > 35
• Unstable cardiac status
• Severe hypertension
• American Society of Anesthesiologists (ASA) Score greater than/equal to 3
• On anti-coagulation therapy (other than aspirin) or has an underlying bleeding disorder
• Active or suspected pelvic infection
• Unable to communicate perception of the stimulation
• Significant surgical complications where in the view of the physician, participation in the study could further complicate subject care (i.e. infection at surgical site, deep venous thrombosis, respiratory complications, etc)
• Treatment with Entereg (alvimopam) during post-operative period