Prevention of Postoperative Intestinal Adhesions with Combined Promethazine and Dexamethasone Therapy

Abstract
A method for the prevention of postoperative intestinal adhesions was presented, based on consideration of the pathophysiology of adhesion formation. By the use of an antihistamine, promethazlne (Phenergan) and an adrenocortical hormone, dexamethasone (Decadron), the inflammatory phase that follows trauma to intestinal serosa can be minimized, and the organization of inflammatory exudate into fibrous adhesions can be delayed. This delay allows serosal cells to grow over the denuded areas of bowel and thus cover any raw flbromuscular surfaces which otherwise could be the seat of adhesion formation. Results of an experimental study in dogs and a series of 27 patients have been very encouraging. Further observations on humans are indicated. Two points must be emphasized: Since ad- hesion formation begins within minutes after any peritoneal injury, prevention of adhesions requires a high level of drug saturation at the time the injury is made. Large doses of the drugs are required to insure maximum benefit. We have used, experimentally, a schedule of 1 mg/kg of each drug, given intramuscularly 6 and 3 hours preoperatively, with the dose repeated in 30 to 100 ml. of saline intraperitoneally as the abdomen is being closed, and intramuscularly every 4 hours for 24 hours to 36 hours postoperatively. For small babies the postoperative dosage of promethazlne is reduced to 0.5 mg/kg to minimize soporific affects. For adults, standardized dosage schedule (independent of weight) appear acceptable.