THE EFFECT OF RANITIDINE ON POSTOPERATIVE INFECTIOUS COMPLICATIONS FOLLOWING EMERGENCY COLORECTAL SURGERY - A RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND TRIAL

Objective and Design: To study the potential effect of ranitidine on p ostoperative infectious complications following emergency colorectal s urgery. A randomized, placebo-controlled, double-blind trial was carri ed out in three university clinics and two county hospitals in Denmark . Patients and Treatment: One hundred and ninety-four consecutive pati ents undergoing acute colorectal surgery for perforated and/or obstruc ted large bowel were randomized in a double-blind fashion to receive r anitidine 100 mg i.v. twice a day commencing at induction of anesthesi a and continued for five days (group I) or i.v. placebo (group II). Al l patients were given 1.5g metronidazole plus 3.0g cefuroxime at the t ime of surgery. Patients with perforation of the colon or rectum were given metronidazole and cefuroxime for further 3 days. All patients we re assessed daily until discharge from the hospital. Thirty patients w ere withdrawn from the study (for reasons such as other diagnosis, ref used to continue, medication not given as prescribed). Main Outcome Me asures: Patients were observed ibr signs of infectious complications; such as wound infection, intraabdominal abscess, septicemia, and pneum onia. Results: Both groups were similar with respect to age, sex, weig ht, duration of surgery, blood transfusions, and site of the procedure , as well as the histologic nature of the underlying disease process. However, the Mannheim Peritonitis Index (MPI) was significantly higher in group I compared with group II (p < 0.05), Wound infection, intraa bdominal abscess, septicemia, and pneumonia were 12.9%, 5.2%, 3.8% and 14%, respectively in group I. In group II, the infectious complicatio ns were 16.1%, 6.8%, 6.9% and 22%, respectively. Twelve patients (13.8 %) in the placebo group developed mure than one complication compared with 5 patients (6.5%) in the ranitidine group. Conclusion: Ranitidine may have a beneficial effect on postoperative infectious complication s in patients following acute colorectal surgery.