by Michael Woodhead  

Perioperative low dose celecoxib markedly reduces the development of paralytic ileus following major abdominal surgery, South Australian researchers have shown.  

In a prospective study of more than 200 patients undergoing elective major addominal surgery at the Flinders Medical centre in Adelaide, researchers compared the effects of 100mg celecoxib daily with the non-selective NSAID diclofenac (50mg daily) and placebo.  

While there was no difference between the groups in resoration of bowel function, there was a significant reduction in paralytic ileus in the celecoxib-treated patients, says Professor David Wattchow and colleagues in the journal Alimentary Pharmacology and Therapeutics (30: 987-98).  

Only one of 74 patients in the celecoxib treated group developed paralytic ileus, compared with seven of 69 patients in the diclofenac group and nine of the 67 patients in the placebo group.  

The researchers say the COX-2 enzyme is thought to play a major role in mechanism that interrupts GI motility, and COX-2 inhibitors were expected to improve bowel function by inhibiting the release of prostaglandins in the bowel wall during surgery.  

They say their findings confirm this hypothesis, and suggest a major clinical benefit, given that paralytic ileus is associated with a four day stay in hospital.  

Any other benefit of COX-2 inhibition on restoration  bowel function may have been masked because patients were allowed early fluid and food intake.  

However, they conclude the considerable reduction  in paralytic ileus seen with the COX-2 inhibitor “encourages the use of this agent in post-opreative recovery programmes,”