Early Diuresis Following Colorectal Surgery
Condition: Colorectal Disorders
Intervention: Furosemide; Celecoxib; Gabapentin
Intervention description: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain or inflammation.; Gabapentin is a oral drug used to treat seizures, postherpetic neuralgia, and restless legs syndrome.
Intervention MeSH terms: Celecoxib; Furosemide; Gabapentin
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 123.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: colorectal surgery; volume status

Summary:

      The purpose of this study is to find out if giving a medicine called furosemide, which is a
      diuretic or water pill, after colon surgery will safely shorten the patient's length of
      hospital stay.
    

Eligibility criteria:

        Inclusion Criteria

          -  All elective colorectal surgeries (CRS) utilizing the enhanced recovery pathway (ERP)

          -  The surgery involves resection

        Exclusion Criteria

        Exclusion Criteria for Randomization:

          -  Surgeries involving intraoperative radiation

          -  Ileostomy closures, when performed as the only surgical intervention

          -  Surgeries involving multiple disciplines (e.g., colorectal plus general surgery,
             colorectal plus gynecology surgery) except for colorectal surgeries plus ureteral
             stent placements.

          -  Chronic loop diuretic therapy (i.e., bumetanide, torsemide, furosemide, ethacrynic
             acid) including as needed administration of such therapy

          -  Patients receiving dialysis

          -  Creatinine clearance, calculated by the Cockcroft-Gault equation, less than 30 mL/min.

          -  Inpatient prior to surgery

          -  Allergy to furosemide

          -  Allergy to sulfa drugs if the allergy involves anaphylactic reaction

          -  Lack of serum creatinine concentration within 3 months preceding the surgery AND
             diagnosis of chronic kidney disease

        Exclusion Criteria for Intervention (applies to both the intervention and control arm):

          -  Patient's weight on postoperative day (POD) #1 and POD #2 is less than preoperative
             weight.

          -  Blood pressure criteria: systolic blood pressure criteria less than 90 mmHg or greater
             than 30 mmHg below baseline on POD #1 and/or POD #2 immediately prior to
             administration of study drug.

          -  Complications within 48 hours of surgery

          -  Abscess (infected fluid collection, treated with CT drainage)

          -  Leak (defined by CT drainage or reoperation)

          -  Wound infection (treated with either antibiotics and/or open packing)

          -  Bowel obstruction (treated with reoperation)

          -  Reoperation

          -  Hemorrhage

          -  Weight change since admission on POD #1: > 5 kg

          -  Acute kidney injury on POD #1 and POD#2 defined as serum creatinine (SCr) increase ≥
             0.3 mg/dL or increase to ≥ 150% to 200% (1.5- to 2-fold) from baseline