Opioid-induced constipation in intensive care patients: relief in sight?

Constipation is the most common gastrointestinal complication associated with opioid therapy in chronic pain patients, and also frequently occurs in sedated intensive care unit patients. Conventional therapy may not provide sufficient relief from constipation, which can be severe enough to limit opioid use or the dose. In a recent study on terminally ill patients suffering from laxative-resistant opioid-induced constipation, Thomas and colleagues demonstrated subcutaneous methylnaltrexone to rapidly induce defecation. This appealing result might also have favourable prospects for intensive care patients, as their outcome is often codetermined by recovery of bowel functioning.

[1]  E. Jonge,et al.  Influence of severity of illness, medication and selective decontamination on defecation , 2006, Intensive Care Medicine.

[2]  C. Spies,et al.  Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia , 2006, BMC gastroenterology.

[3]  P. Factor,et al.  GI complications in patients receiving mechanical ventilation. , 2001, Chest.

[4]  E. Wittbrodt,et al.  Low-dose oral naloxone reverses opioid-induced constipation and analgesia. , 2002, Journal of pain and symptom management.

[5]  J. Foss,et al.  Oral methylnaltrexone for opioid-induced constipation. , 2000, JAMA.

[6]  N. Stambler,et al.  Methylnaltrexone for opioid-induced constipation in advanced illness. , 2008, The New England journal of medicine.

[7]  S. Nurko,et al.  Opioid side effects--mechanism-based therapy. , 2008, The New England journal of medicine.

[8]  Sobhy M. Mostafa,et al.  Constipation and its implications in the critically ill patient. , 2003, British journal of anaesthesia.

[9]  Spencer S. Liu,et al.  ADL 8‐2698, a trans‐3,4‐dimethyl‐4‐ (3‐hydroxyphenyl) piperidine, prevents gastrointestinal effects of intravenous morphine without affecting analgesia , 2001, Clinical pharmacology and therapeutics.

[10]  T. Karrison,et al.  Tolerability, Gut Effects, and Pharmacokinetics of Methylnaltrexone Following Repeated Intravenous Administration in Humans , 2005, Journal of clinical pharmacology.

[11]  N. Nguyen,et al.  The impact of admission diagnosis on gastric emptying in critically ill patients , 2007, Critical care.

[12]  A. Sanz Rubiales,et al.  Methylnaltrexone for opioid-induced constipation in advanced illness. , 2008, The New England journal of medicine.