Common Drug Found to Prevent Adhesions

In an accidental discovery, researchers have found that short-term use of the COX-2 inhibitor Celebrex, a drug for arthritis whose use is now under investigation, can prevent adhesions following surgery. The finding was reported in the January 25, 2000, issue of Annals of Surgery.

Adhesions develop in 55-90% of patients undergoing surgery, causing pain and complications. Adhesions are a major cause of bowel obstruction and infertility, so repeat surgery is often required to cut through them. No good way to prevent them has been found. Now, researchers studying the effects of Celebrex on liver rejuvenation after injury happened to notice there were no adhesions, so they decided to conduct a formal experiment. After undergoing surgery, groups of six to 18 mice received either Celebrex or another COX-2 inhibitor, Vioxx, nonselective COX inhibitors (such as ibuprofen and aspirin), or placebo for 10 days.

At the end of 10 days, the placebo group had obvious abdominal adhesions. Mice receiving COX inhibitors had a slight reduction in adhesions, those receiving nonselective COX inhibitors had a larger reduction, and 55% (six of 11) of those given Celebrex were completely adhesion-free. After observing the group for another 25 days, the adhesion score (based on the extent and removal difficulty) was only 1 in the Celebrex group, 5 in the Vioxx group, 8 in the aspirin group, and 11 in the placebo group.

Currently, the most common method of preventing adhesions uses a barrier agent or gel to separate the abdominal surfaces and prevent them from binding together. However, these treatments can suppress the immune system, cause infection, and impair healing.

"If Celebrex works in humans, you could give it to patients on the day of abdominal surgery and the 10 days after surgery,” noted senior investigator Dr. Mark Puder, of the department of surgery and the vascular biology program at Children's Hospital Boston (MA, USA). Dr. Puder believes that COX-2 inhibitors could also reduce adhesions after gynecologic and thoracic surgery.




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Children's Hospital Boston