The Effect of Chewing Gum on Improving Bowel Activity during the Postoperative Period in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

Introduction:Postoperative constipation significantly impacts the quality of life during the immediate postoperative period.Non-pharmacological interventions are preferred so that we can reduce the use of synthetic drugs and their complications.This study evaluates the effect of using chewing gum over the perioperative period on improving bowel activity during the postoperative periods in patients who underwent total knee replacement (TKR).Materials and methods: A prospective randomized controlled trial was conducted on 252 patients who underwent TKR between December 2020 and August 2021.Only patients having a natural defecation pattern preoperatively and not suffering from any diseases affecting bowel movements were considered.The Patients were classified into two groups, and computer-generated numbers did the randomization.The postoperative analgesia and rehabilitation protocol were the same for both groups.The sugar-free chewing gum (for better glycemic control) was given to the study group to chew for approximately 15 min every 6th hour from shifting out of the operation theater until the first stool was passed.For the control group, 200 mL of warm water (37 degrees) was given every 6th hour from shifting out of the operation theater until the first stool was passed.The patients were asked whether they passed 1st flatus or 1st stool at fixed intervals. Results:The first flatus was passed on the day of surgery by 71% of patients from the study group and 50% from the control group.The first stool was passed postoperative day 1 by 71% of patients from the study group and 20% from the control group.These differences are statistically significant.Conclusion: Chewing gum significantly improved bowel activity in postoperative TKR patients and would be a safe, effective, non-pharmacological method for decreasing postoperative constipation.