Effectiveness of early mobilisation versus laxative use in reducing constipation in post-operative orthopaedic patients: an integrative review

Main Article Content

Omowumi Okusaga
Rebecca Mowat
Catherine Cook

Keywords

Exercise, mobility, opioid-induced constipation, bowel management protocols, patient education, orthopaedic, post-operative

Abstract

Objective: To explore which nursing intervention: early mobilisation versus laxative use, is more effective in reducing constipation in post-operative orthopaedic patients who require strong analgesia. Background: The use of opioids to manage pain in orthopaedic patients causes post-operative constipation. Nursing interventions used to relieve constipation in patients post-operatively include encouraging patients to eat a high fibre diet, to increase their hydration, to mobilise and to use laxatives. However, varying results have been demonstrated on the effects of early mobilisation and laxative use, specifically in managing opioid-induced constipation. Study design and methods: An integrative literature review was used to identify articles from online databases between January 2000 and June 2020. Grey literature was also utilised. Data were quality appraised, extracted, and thematic analysis was used to synthesise the results. Results: The use of laxatives was effective in some studies, while some studies found laxatives to be either ineffective or partially effective. Most of the studies and grey literature recommended early mobilisation, however not in isolation, but in conjunction with other interventions including increased fibre, fluid intake and laxative use. Discussion: Although the benefits of early mobilisation have been identified, it is not advocated for independently and is usually advocated for in conjunction with other interventions such as a diet high in fibre, increased water intake along with laxative use. Laxatives used as the first line of constipation treatment are not always effective. Multiple doses are often required as they may not deal with the underlying cause of opioid-induced constipation. Conclusion: This study determined there is no clear evidence to support a singular course of action; early mobilisation or laxative use. Each intervention potentially contributes to preventing constipation therefore both interventions should be utilised concurrently. Implications for research, policy, and practice: Post-operative constipation is an ongoing problem in this subset of patients. However, there is always a need for reviewing current practices and re-educating and reminding patients and staff of the benefits of a multipronged approach. Practices recommended include discouraging bedpans, following protocols, documentation and having an open dialogue with patients. Further research is needed to examine the effectiveness of early mobilisation only in relieving constipation in post-operative orthopaedic patients and orthopaedic patients in general who require strong analgesia.


What is already known about the topic?



  • The continuous use of opioids to manage pain post-operatively in orthopaedic patients results in opioid-induced constipation.

  • The advice given currently advocates a mix of pharmacological and non-pharmacological interventions to relieve constipation.


What this paper adds:



  • There is no evidence that either early mobilisation or laxatives are effective in preventing post-operative constipation.

  • Both interventions should be utilised concurrently.

  • Research addressing whether early mobilisation only can relieve constipation is needed.

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