Other Ways to Stimulate Postoperative Bowel Function

Abstract

In Response: We are grateful for Dr. Herschman's interest in our study. Neostigmine in controlled studies has not shown consistent efficacy in shortening the course of postoperative ileus [1]. Additionally, because it can cause powerful contractures of the intestine, some surgeons are concerned about its use immediately after a colonic anastomosis [2]. As a long-acting anticholinesterase inhibitor, neostigmine can have a profound effect on heart rate, salivation, nausea [3], and reactive airways. Patients receiving this drug require postadministration monitoring. The cost of administrating IV neostigmine is therefore considerable if one includes the time required to observe the patient after the drug is given. Assuming that IV neostigmine is clinically effective in decreasing the duration of postoperative ileus, lidocaine still has other advantages that make it a better pharmacologic agent. These include: no additional monitoring (the drug is given in the operating room and postanesthesia care unit, where appropriate monitoring is routine), a low cost, very few patient contraindications, and-most significantly-a reduction in postoperative pain. We believe that the benefits of perioperative lidocaine warrant its use with patients undergoing radical retropubic prostatectomy, and possibly other surgeries where postoperative ileus is anticipated. Dr. Herschman's use of neostigmine is a treatment option for ileus, whereas IV lidocaine is a preemptive therapy aimed at attenuating the duration of ileus. The differences in indication, monitoring requirements, patient selection, and effects on postoperative pain between lidocaine and neostigmine would make any comparative study difficult to interpret clinically. Scott Groudine, MD Philip D. Lumb, MBBS Department of Anesthesiology; Albany Medical Center; Albany, NY 12208