Effects and safety of neostigmine for postoperative recovery of gastrointestinal function: a systematic review and meta-analysis

Abstract

Background: The purpose of this study was to evaluate the clinical effects and safety of neostigmine for the postoperative recovery of gastrointestinal function. Methods: We performed a literature search of multiple databases [PubMed, Web of Science, Cochrane Library and China National Knowledge Internet (CNKI)] to retrieve studies comparing the postoperative gastrointestinal function of neostigmine and control groups. Review Manager 5.2 was applied for the analysis of heterogeneity, sensitivity, and bias. Results: After screening the articles, 17 trials involving 1,589 postoperative patients that met the eligibility criteria were included. The results suggested that neostigmine improved the first passage of flatus [standard mean difference (SMD) =−3.00; 95% confidence interval (CI): (−4.03, −1.97); P<0.001), first defecation [SMD =−3.75; 95% CI: (−5.25, −2.24); P<0.001], time of bowel sound recovery [SMD =−3.42; 95% CI: (−4.49, −2.36), P<0.001], and gastrointestinal function recovery [risk ratio (RR) =1.84; 95% CI: (1.19, 2.86); P=0.007]. Compared to the control group, the neostigmine group had lower rates of abdominal distention [RR =0.39; 95% CI: (0.18, 0.87); P=0.02; I 2 =76%] and overall adverse events [RR =0.49; 95% CI: (0.29, 0.82); P=0.007]. However, two groups had no difference in postoperative nausea and vomiting (PONV) [RR =0.50; 95% CI: (0.21, 1.23); P=0.13], and respiratory complications [RR =0.96; 95% CI: (0.20, 4.53); P=0.96]. Sensitivity and publication bias analyses showed that these results were robust and exhibited little publication bias. Discussion: Small doses of neostigmine may promote the recovery of postoperative gastrointestinal function without obvious side effects.

Suspected lidocaine toxicity and the use of metoclopramide and neostigmine to treat post‐operative small intestinal ileus in a donkey

“…1,55 In humans, a recent systematic review of the literature concluded that small doses of neostigmine may promote the recovery of postoperative gastrointestinal function without obvious side effects. 56 A short case series documented that infusion doses of 0.007-0.05 mg/kg/h were used successfully in children to treat refractory POI. 54 In horses, the evidence supporting the use of neostigmine as a prokinetic agent is limited.…”

“…It is thought to enhance intestinal motility by inhibiting cholinesterase activity and thereby prolongs the presence of acetylcholine in the neuromuscular junction 1,55 . In humans, a recent systematic review of the literature concluded that small doses of neostigmine may promote the recovery of postoperative gastrointestinal function without obvious side effects 56 . A short case series documented that infusion doses of 0.007–0.05 mg/kg/h were used successfully in children to treat refractory POI 54 …”

Efficacy and safety of neostigmine on treating gastrointestinal dysmotility in severe acute pancreatitis patients: study protocol for a randomized controlled trial

“…Neostigmine, an acetylcholinesterase inhibitor (ACI), is known to increase upper and lower gastrointestinal motility [25][26][27]. It has been used for postoperative recovery of gastrointestinal function [28,29]. One study have shown that neostigmine could reduce intraabdominal pressure (IAP) in SAP patients [30].…”

General anaesthesia-related complications of gut motility with a focus on cholinergic mechanisms, TRP channels and visceral pain

“…However, there has not been much subsequent progress towards delineating specific molecular and/or cellular pathways involved. On the other hand, among various prokinetic drugs used for POI treatment ( Venara et al, 2016 ), low concentrations of neostigmine, which is an inhibitor of acetylcholinesterase, may be beneficial (results of the recent systematic review and meta-analysis performed by Liao et al, 2021 ), which calls for a better understanding of the possible dysfunction of the acetylcholine-mediated signal transduction during the impairment of GI motility by general anaesthetics.…”