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WSU Medical School
Wayne State University
Background and hypothesis: Postoperative ileus (POI) is a common complication after spine surgery which often leads to increased length of stay and associated co-morbidities. While the use of laxatives and supportive therapy can be effective in resolving the symptoms, the use of oral µ-opioid receptor antagonists has not been evaluated in this field. Per os (PO) naloxone is a µ-opioid receptor antagonist with limited systemic absorption with effects mainly confined to the gastrointestinal tract. The aim of this study is to evaluate the safety and potential effectiveness of oral naloxone and its role in resolving postoperative ileus in postoperative spine patients.Material and Methods: A descriptive study of patients who had received oral naloxone after spine surgery was undertaken. Twenty-nine consecutive patients were identified between 2015 and 2018. POI was subdivided into postoperative constipation, ileus, prolonged ileus, and recurrent ileus. To assess for withdrawal symptoms, we collected pain scores, opioid intake, and vital signs before and after PO naloxone administration. Primary endpoint was time to resolution of ileus and discharge. Patients were followed for three months to record any long-term medication adverse events.Results: The mean age was 62 years old; 18 were male (62.1%), and 14 (48.3%) were chronic opioid users. All patients received opioids postoperatively as part of their analgesia therapy. There was no significant difference between pre- and post-PO naloxone pain scores, opioid intake, or vital signs to indicate withdrawal symptoms. Twenty-six patients (89.7%) had resolution of their POI the same day as PO naloxone administration and two more the following day. No complications were directly linked to PO naloxone intake.Conclusion: Per os naloxone therapy was safe and effective in relieving symptoms associated with postoperative constipation and ileus in patients recovering from spine surgery in this preliminary study. Further prospective, cohort or randomized controlled studies are needed to see the true value of PO naloxone in reducing length of stay and resolving postoperative ileus.
Klomparens, Eric; Asmaro, Karam; Pawloski, Jacob; Zakaria, Hesham Mostafa; Jones, Mathew; Walters, Beverly C; and Schwalb, Jason, "The Safety of Per Os Naloxone and its Efficacy in Resolving Postoperative Ileus in Patients Undergoing Spine Surgery" (2019). Clinical Research. 60.