Peripherally acting mu-opioid receptor antagonists and postoperative ileus: mechanisms of action and clinical applicability.

Published

Journal Article (Review)

Postoperative ileus (POI), a transient cessation of coordinated bowel function after surgery, is an important health care problem. The etiology of POI is multifactorial and related to both the surgical and anesthetic pathways chosen. Opioids used to manage surgical pain can exacerbate POI, delaying gastrointestinal (GI) recovery. Peripherally acting mu-opioid receptor (PAM-OR) antagonists are designed to mitigate the deleterious effects of opioids on GI motility. This new class is investigational for POI management with the goal of accelerating the recovery of upper and lower GI tract function after bowel resection. In this review, we summarize the mechanisms by which POI occurs and the role of opioids and opioid receptors in the enteric nervous system, discuss the mechanism of action of PAM-OR antagonists, and review clinical pharmacology and Phase II/III POI trial results of methylnaltrexone and alvimopan. Finally, the role of anesthesiologists in managing POI in the context of a multimodal approach is discussed.

Full Text

Cited Authors

  • Viscusi, ER; Gan, TJ; Leslie, JB; Foss, JF; Talon, MD; Du, W; Owens, G

Published Date

  • June 2009

Published In

Volume / Issue

  • 108 / 6

Start / End Page

  • 1811 - 1822

PubMed ID

  • 19448206

Pubmed Central ID

  • 19448206

Electronic International Standard Serial Number (EISSN)

  • 1526-7598

International Standard Serial Number (ISSN)

  • 0003-2999

Digital Object Identifier (DOI)

  • 10.1213/ane.0b013e31819e0d3a

Language

  • eng