methylnaltrexone and Intestinal-Perforation

Postoperative ileus (POI) is a surgical complication resulting in increased morbidity and length of stay (LOS). Usual care for POI includes bowel rest and gastric decompression. It has been questioned if methylnaltrexone (MNTX), a peripheral opioid antagonist, could be used as treatment for POI. The purpose of this study was to determine if MNTX is effective and safe for POI treatment.. This single-center, retrospective cohort study included patients ⩾ 18 years with a POI. Patients with acute colonic pseudo-obstruction, small bowel obstruction, and gastrointestinal malignancy were excluded. The intervention was MNTX administration. The primary outcome was time to ileus resolution. Secondary outcomes included LOS, duration of nasogastric tube, total parenteral nutrition requirement, and incidence of gastrointestinal perforations.. 110 patients were included in the analysis; 28 received MNTX. Time to ileus resolution was 9.9 days for the MNTX group and 11.4 days for the control group (. For the treatment of POI, MNTX did not significantly reduce time to resolution of ileus, LOS, duration of gastric decompression, or TPN requirements. However, no gastrointestinal perforations were seen, indicating that MNTX may be safely used in these patients.

Topics: Female; Humans; Ileus; Intestinal Perforation; Intubation, Gastrointestinal; Length of Stay; Male; Middle Aged; Naltrexone; Narcotic Antagonists; Parenteral Nutrition; Postoperative Complications; Quaternary Ammonium Compounds; Retrospective Studies; Time Factors; Treatment Outcome

Pain management with opioids is often limited by medication side effects. One of the most common and distressing side effects is opioid-induced constipation (OIC), a syndrome that is now getting significant national attention. We report the case of an opioid-dependent 56-year-old man who underwent lumbar decompression for spinal stenosis. Postoperatively, he developed OIC and Ogilvie syndrome, then following treatment with methylnaltrexone experienced an acute bowel perforation. We briefly review the recommended management of OIC as well as indications and contraindications of methylnaltrexone and similar new medications.

Topics: Analgesics, Opioid; Colonic Pseudo-Obstruction; Constipation; Decompression, Surgical; Humans; Hydromorphone; Intestinal Perforation; Low Back Pain; Male; Methadone; Middle Aged; Naltrexone; Narcotic Antagonists; Opioid-Related Disorders; Oxycodone; Postoperative Complications; Quaternary Ammonium Compounds; Spinal Stenosis

Topics: Analgesics, Opioid; Humans; Intestinal Perforation; Naltrexone; Narcotic Antagonists; Palliative Care; Quaternary Ammonium Compounds; United States