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 22 January 2018

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News

The selective postoperative inhibition of gastrointestinal opioid receptors benefits patients

Selective postoperative inhibition of gastrointestinal opioid receptors speeds recovery of bowel function and shortens the duration of hospitalization, according to research published in this week's New England Journal of Medicine.

News image

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Researchers from Austria and the USA investigated the outcomes of selective postoperative inhibition of gastrointestinal opioid receptors.

They studied the effects of ADL 8-2698 on postoperative gastrointestinal function and the length of hospitalization. ADL 8-2698 is an investigational opioid antagonist with limited oral absorption, which does not readily cross the blood-brain barrier.

A total of 79 patients (including 1 whose surgery was canceled) were included in the study. They were randomly assigned to receive one capsule containing 1 mg or 6 mg of ADL 8-2698, or an identical-appearing placebo capsule, 2 hours before major abdominal surgery. This was then repeated twice daily until the first bowel movement or until discharge from the hospital.

Data were analyzed for 26 patients in each of the 3 groups. All received opioids for postoperative pain relief.

The opioid antagonist reduced time until:
- First passage of flatus
- First bowel movement
- Discharge
New England Journal of Medicine

Observers who were unaware of the group assignments evaluated the outcomes.

Of the patients, 15 underwent partial colectomy and 63 underwent total abdominal hysterectomy.

The researchers found that those given 6 mg of ADL 8-2698 had significantly faster recovery of gastrointestinal function than those given placebo.

The median time to the first passage of flatus decreased from 70 to 49 hours and the median time to the first bowel movement decreased from 111 to 70 hours.

In addition, the median time until patients were ready for discharge decreased from 91 to 68 hours.

Effects in the group that received 1 mg of ADL 8-2698 were less pronounced.

Dr Akiko Taguchi, of Washington University, St. Louis, concluded on behalf of the team, "Selective inhibition of gastrointestinal opioid receptors, by an antagonist with limited oral absorption that does not readily cross the blood-brain barrier, speeds recovery of bowel function and shortens the duration of hospitalization."

N Engl J Med 2001; 345 (13): 935-40
28 September 2001

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