Evaluation of Preoperative Administration of Rectal Indomethacin in Reducing the Severity of Ileus after Open Cholecystectomy

Document Type : Original Article

Authors

1 Assistant Professor of Surgical Oncology, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associated Professor of Minimal Invasive Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Professor of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor of Social Medicine, Department of Epidemiology and Biostatistics, Mashhad University of Medical Sciences, Iran.

Abstract

Introduction:
Ileus or transient intestinal motility disorder is one of the problems after surgery, which poses challenges facing the medical team. Previous studies approved the preemptive effects of non-steroidal anti-inflammatory drugs (NSAIDs) on ileus; however, the majority of them have focused on animal models. This study aimed to investigate the effects of administration of rectal indomethacin in reducing ileus in patients who underwent cholecystectomy.
Materials and Methods:
This randomized controlled trial included 40 patients with cholelithiasis who were divided into two groups of indomethacin (n=20) and placebo (n=20). The indomethacin group received 100 mg rectal indomethacin before the operation. Cholecystectomy was performed using an open technique. The recovery of bowel functions (i.e. the time of the first flatus passage, return of appetite, and total dosage of opioid analgesic medications) was evaluated in this study.
Results:
Time of the first ileus passage (P=0.004), return of appetite time (P=0.06), and reduction of opioid usage (65.62±5.5 mg/day versus 93.26±2.56) were significantly shorter in the indomethacin group, compared to the placebo group. Furthermore, none of the patients had any significant indomethacin-related complications.
Conclusion:
According to the outcomes of this study, it is concluded that preoperative administration of NSAIDS can be helpful in postoperative ileus reduction.

Keywords

References

  1. Josephs MD, Cheng G, Ksontini R, Moldawer LL, Hocking MP (1999). Products of cyclooxygenase-2 catalysis regulate postoperative bowel motility. J Surg Res ; 86(1):50-4.
  2. Mc Cormaek K (1994). Non–steroidal anti–inflammatory drugs and spinal nociceptive processing. Pain; 59: 9-44.
  3. Moore PA, Werther JR, Seldin EB, Stevens CM (1986). Analgesic regimens for third molar surgery: Pharmacologic and behavioral considerations. J AM Dent Assoc; 113 (5): 739-44.
  4. Desjardins PJ, Grossman EH, Kuss ME, Talwalker S, Dhadda S, Baum D, et al (2001). The Injectable cyclo oxygenase–2–specific Inhibitor Parecoxib sodium has analgesic efficacy when administered preoperatively. International Anesthesia research society; 93 (3): 721-727.
  5. De Winter BY, Boeckxstaens GE, De Man JG, Moreels TG, Herman AG, Pelckmans PA (1998). Differential effect of Indomethacin and ketorolac on postoperative ileus in rats. Eur J Pharmacol; 344(1):71-6.
  6. Chen JY, Wu GJ, Mok MS, Chou YH, Sun WZ, Chen PL, et al (2005). Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients--a prospective, randomized, double-blind study. Acta Anaesthesiol Scand; 49(4):546-51.
  7. Korolkiewicz RP, Ujda M, Dabkowski J, Ruczyński J, Rekowski P, Petrusewicz J (2003). Differential salutary effects of nonselective and selective COX-2 inhibitors in postoperative ileus in rats. J Surg Res; 109(2):161-9.
  8. Bouras EP, Burton DD, Camilleri M, Stephens DA, Thomforde GM (2004). Effect of cyclooxygenase-2 inhibitors on gastric emptying and small intestinal transit in humans. Neurogastroenterol Motil;16(6):693-5.
  9. Shafiq N, Malhotra S, Pandhi P (2002). Effect of cyclooxygenase inhibitors in postoperative ileus: an experimental study. Methods Find Exp Clin Pharmacol; 24(5):275-8.
  10. Ferraz AA, Cowles VE, Condon RE, Carilli S, Ezberci F, Frantzides CT, et al (1995). Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg; 61(12):1079-83.
  11. Pairet M, Ruckebusch Y (1989). On the relevance of non-steroidal anti-inflammatory drugs in the prevention of paralytic ileus in rodents. J Pharm Pharmacol; 41(11):757-61.
  12. Behm B, Stollman N (2003). Postoperative ileus: etiologies and interventions. Clin Gastroenterol Hepatol; 1(2):71-80.
  13. Kreis ME, Kasparek MS, Becker HD, Jehle EC, Zittel TT (2003). [Postoperative ileus: part II (Clinical therapy)]. Zentralbl Chir; 128(4):320-8.
  14. Priya V, Divatia JV, Sareen R, Upadhye S (2002). Efficacy of intravenous ketoprofen for Pre –emptive analgesia. J post-grad med;48(2):109-12.
  15. Seibert K, Zhang Y, Leahy K, Hauser S, Masferrer J, Perkins W, et al (1994). Pharmacological and biochemical demonstration of the role of cyclooxygenase -2 in inflammation and pain. Proc Natl Acad Sci USA; 91: 12013-7.
  16. Campbell WI, Kendrick R, Patterson C (1990). Intravenous diclofenac sodium. Does its administration before operation suppress post- operative pain? Anaesthesia; 45: 763-6.
  17. McCormack K, Brune K (1991). Dissociation between nociceptive and anti- inflammatory drugs. A survey of their analgesic efficacy. Drugs; 41: 533-47.
  18. Stein J, Zeuzem S, Uphoff K, Laube H (1994). Effects of prostaglandins and Indomethacin on gastric emptying in the rat. ; 47(1):31-40.
  19. Kokki H, Salonon A, Nikanne E (2001). Perioperative intravenous ketoprofen neither prolongs operation time nor delays discharge after adenoidectomy in children. Pediatric Anaesthesia; 11(1):59-64.
  20. Kokki H, Homan E, Tuovinen K (1999). Perioperative treatment with i.v. ketoprofen reduces pain and vomiting in children of the strabismus surgery. Acta Anaesthesiol scand; 43: 13-18.
  21. Marret E, Bonnet F (2007). Perioperative anti – inflammatory drug use: which evidences for their utility and safety? Ann Fr Anesth Reanim; 26(6): 535-9.
  22. Sapolya O, Karamanhoglu B, Memis D (2007). Analgesic effects of lornoxicam after total abdominal hysterectomy. J opioid manag; 3(3): 155-9.
  23. Kissin I(1996).Pre- emptive analgesia: why its effect is not always obvious. Anesthesiology; 84(5):1015-9.
  24. Sinatra RS (2006). Peripherally acting mu-opioid-receptor antagonists and the connection between postoperative ileus and pain management: The anesthesiologist's view and beyond. J Perianesth Nurs; 21(2A Suppl):S16-23.
Journal of Patient Safety & Quality Improvement
Volume 8, Issue 4
October 2020
Pages 207-211

Files

Share

How to cite

Statistics