NEOSTIGMINE FOR THE TREATMENT OF POSTOPERATIVE ILEUS (PROSPECTIVE RANDOMIZED STUDY)

Objective. Assessing the effectiveness of neostigmine for the treatment of postoperative ileus after colorectal cancer surgery. Design. Prospective randomized study. Material and methods. Patients with postoperative ileus were recruited for the study from the Ryzhikh State Scientific Center of Coloproctology (Moscow, Russia). Postoperative ileus was defined as marked colonic distention in the absence of mechanical obstruction at 72 hours after surgery. After X-ray control patients with postoperative ileus were randomized in two groups. Neostigmine was administered subcutaneously in 1 mg dose every 6 hours. Primary endpoint was colonic decompression 24 hours after starting therapy. Side effects were also analyzed. Results. Forty-four patients were included in the study. Fourteen (63,6%) of 22 patients who received neostigmine had colonic decompression after 24 hours, as compared with 12 (54,5%) of 22 patients in control group (p=0.76). Abdominal pain significantly increased in neostigmine group (p=0.001). Hypersalivation was marked in 3 cases in neostigmine group. Bradycardia after neostigmine developed in 1 case and was treated with atropine (p=1.0). Conclusion. Neostigmine is ineffective treatment for postoperative ileus. Side effects include increased saliva, abdominal pain, and bradycardia.

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