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The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy.

Publication ,  Journal Article
Lenis, AT; Golla, V; Lec, PM; Johnson, DC; Faiena, I; Lee, C; Rahman, S; Chamie, K
Published in: World J Urol
December 2020

PURPOSE: To assess the impact of N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, on the post-operative recovery of patients undergoing robotic-assisted radical cystectomy for bladder cancer. METHODS: We retrospectively reviewed patients undergoing robotic-assisted radical cystectomy by a single surgeon (KC) prior to (control group) and after (treatment group) the routine use of N-methylnaltrexone. Kaplan-Meier curves and the log-rank test were used to quantify time to flatus, bowel movement, and discharge. Daily mean opioid use, daily pain assessment rating, and episodes of severe pain (7-10/10) were compared. Gastrointestinal-related complications, including ileus, emesis, and/or need for post-op nasogastric tube placement, and 30-day readmissions were also compared between groups. Charge capture data were compared between groups to analyze cost impact. RESULTS: 29 patients each in the control and treatment group met inclusion criteria. Patients receiving N-methylnaltrexone had reduced length of stay compared with no N-methylnaltrexone (median 4 vs. 7 days, p < 0.01). Time to flatus and bowel movement, however, were similar. In a multivariable analysis controlling for possible confounders, however, the improvement in length of stay associated with N-methylnaltrexone use did not reach statistical significance (p = 0.11). Episodes of severe pain and composite gastrointestinal-related complications were reduced in the N-methylnaltrexone group (44.8% vs. 10.3%, p < 0.01). The reduction in length of stay was associated with approximately $10,500 in cost savings per patient. CONCLUSIONS: In this study, N-methylnaltrexone was associated with reduced length of stay, fewer episodes of severe pain, and reduced costs. These results provide the impetus for further study.

Duke Scholars

Published In

World J Urol

DOI

EISSN

1433-8726

Publication Date

December 2020

Volume

38

Issue

12

Start / End Page

3113 / 3119

Location

Germany

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Quaternary Ammonium Compounds
  • Postoperative Period
  • Postoperative Complications
  • Narcotic Antagonists
  • Naltrexone
 

Citation

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MLA
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Lenis, A. T., Golla, V., Lec, P. M., Johnson, D. C., Faiena, I., Lee, C., … Chamie, K. (2020). The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy. World J Urol, 38(12), 3113–3119. https://doi.org/10.1007/s00345-020-03117-y
Lenis, Andrew T., Vishnukamal Golla, Patrick M. Lec, David C. Johnson, Izak Faiena, Carol Lee, Siamak Rahman, and Karim Chamie. “The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy.World J Urol 38, no. 12 (December 2020): 3113–19. https://doi.org/10.1007/s00345-020-03117-y.
Lenis, Andrew T., et al. “The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy.World J Urol, vol. 38, no. 12, Dec. 2020, pp. 3113–19. Pubmed, doi:10.1007/s00345-020-03117-y.
Lenis AT, Golla V, Lec PM, Johnson DC, Faiena I, Lee C, Rahman S, Chamie K. The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy. World J Urol. 2020 Dec;38(12):3113–3119.
Journal cover image

Published In

World J Urol

DOI

EISSN

1433-8726

Publication Date

December 2020

Volume

38

Issue

12

Start / End Page

3113 / 3119

Location

Germany

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Quaternary Ammonium Compounds
  • Postoperative Period
  • Postoperative Complications
  • Narcotic Antagonists
  • Naltrexone