929

Gathers, Kimberly; Khan, Fawad; Petros, Karen

doi:10.1097/01.ccm.0000440167.33609.7d

Cited by 1 publication

(5 citation statements)

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“…There have been case reports of GI perforations associated with MNTX administration, but MNTX was found to be safe and well-tolerated in randomized and retrospective studies and case reports. 4,5,8,[11][12][13][14][15][16][17][18] In our study, no GI perforations were observed. This addresses an important concern with use of this medication and sheds further light on its safety in this patient population Our study has several limitations.…”

Section: Discussionsupporting

confidence: 43%

“…In the study by Gathers et al, the median dose of subcutaneous MNTX for POI treatment was .15 mg/kg with 63% of patients receiving one-time doses. 8 They did not find a correlation between dose and efficacy. Two retrospective studies analyzing subcutaneous MNTX use for opioid-induced constipation (OIC) in critical care patients also used one-time doses, but 1 study administered .15 mg/kg/dose while the other study used the weight-based dosing algorithm described for OIC with advanced illness.…”

Section: Discussionmentioning

confidence: 94%

“…This is comparable to the 14.5 hours reported in a retrospective study describing the use of MNTX use for POI treatment. 8 Studies of MNTX use for postoperative and critical illness OIC report similar times to laxation (12-30 hours). [11][12][13][14] Our study adds to the evidence that MNTX can lead to laxation within 24 hours of administration.…”

Section: Discussionmentioning

confidence: 99%

“…Although MNTX has been studied in randomized and retrospective trials for prevention of POI, data for use as a treatment of POI are limited to a single retrospective study of 86 surgical patients comparing MNTX dosing regimens and time to first bowel movement. 4,5,8,9 In our single-center, retrospective cohort study, we compared the time to POI resolution in patients who received usual care vs those administered MNTX in addition to usual care for the treatment of POI. Time to resolution of ileus did not differ significantly for patients receiving MNTX.…”

Section: Discussionmentioning

confidence: 99%

“…While the literature provides recommendations for prevention of POI, studies focused on treatment strategies are lacking. 4,5,8,9 Current POI treatment is limited to bowel rest with nutrition support, decompression of the stomach with a NGT, and laxatives including suppositories and/or enemas. 10 The purpose of our study was to determine if methylnaltrexone, in addition to usual care, is safe and effective for the treatment of postoperative ileus.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy and Safety of Methylnaltrexone for the Treatment of Postoperative Ileus

Beavers

Orton

Atchison

et al. 2021

The American Surgeon

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Background 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. Methods 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. Results 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 ( P = .38). Duration of gastric decompression was 4.6 days for the MNTX group and 4.2 days for the control group ( P = .71). Length of stay was 19.9 days for the MNTX group and 19.7 days for the control group ( P = .96). The percentage of TPN requirement was 17.9% in the MNTX group and 22.0% in the control group ( P = .65). No gastrointestinal perforations were observed in either group. Conclusion 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.

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