From the *Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University; and †Thomas Jefferson University Hospital, Philadelphia, PA.
Reg Anesth Pain Med. 2017 Nov/Dec;42(6):767-777. doi: 10.1097/AAP.0000000000000671.
Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting μ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies.
阿片类药物引起的便秘会对慢性疼痛患者的生活质量产生负面影响，超过三分之一的患者会受到影响。另一种相关但不同的疾病是术后肠梗阻，这是手术后胃肠道蠕动的一种异常模式。非选择性μ-阿片受体拮抗剂可逆转便秘和阿片类药物引起的肠梗阻，但会穿过血脑屏障，可能会逆转镇痛作用。外周作用μ-阿片受体拮抗剂靶向μ-阿片受体而不逆转镇痛作用。美国食品和药物管理局批准了三种此类药物。我们回顾了研究阿片洛哌丁胺、甲基纳曲酮和纳洛酮治疗阿片类药物引起的便秘或术后肠梗阻的随机对照试验的文献。外周作用μ-阿片受体拮抗剂可能有效治疗阿片类药物引起的肠道功能障碍和术后肠梗阻，但由于研究的不一致性和证据质量相对较低，无法得出明确的结论。由于终点不同且没有头对头研究，因此比较药物比较困难。
