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Wei X, Wang Z, Chen Y, Wang X, Ma L, Hou J, Zhao L. Administration of flurbiprofen axetil and dezocine for the postoperative analgesia in patients with non‑small cell lung cancer: A randomized, controlled study. Oncol Lett 2024; 28:294. [PMID: 38737980 PMCID: PMC11082835 DOI: 10.3892/ol.2024.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/06/2024] [Indexed: 05/14/2024] Open
Abstract
Flurbiprofen axetil or dezocine monotherapy has been applied for analgesia of postoperative non-small cell lung cancer (NSCLC); however, their combination is rarely investigated. Consequently, the present study aimed to explore the effect of flurbiprofen axetil plus dezocine on postoperative pain, surgical outcomes and its safety profile in patients with NSCLC. A total of 150 patients with resectable NSCLC were enrolled and randomized into three groups: i) The flurbiprofen axetil plus dezocine group (n=50), ii) the flurbiprofen axetil group (n=51) and iii) the dezocine group (n=49). A total of 50 mg flurbiprofen axetil, 5 mg of dezocine or their combination were administered intravenously 3 h prior to surgery and subsequently every 12 h until day 3 (D3) following surgery. The postoperative pain was lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil group at 6 h (P=0.008), 12 h (P=0.003), day 1 (D1) (P=0.013), day 2 (D2) (P=0.036) and D3 (P=0.010); in addition, it was lower in the flurbiprofen axetil plus dezocine group compared with that of the dezocine group at 6 h (P=0.010), 12 h (P=0.012) and D1 (P=0.020). Patient-controlled analgesia consumption was also lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil (P=0.010) and dezocine (P=0.002) groups. Furthermore, the length of hospital stay was lower in the flurbiprofen axetil plus dezocine group compared with that of the flurbiprofen axetil (P=0.008) and dezocine (P=0.048) groups, while other surgical outcomes and adverse events were similar among these three groups. Moreover, the expression of tumor necrosis factor-α was lower in the flurbiprofen axetil plus dezocine group compared with that of the dezocine group at 12 h (P<0.001), D1 (P<0.001) and D3 (P=0.033). The data indicated that flurbiprofen axetil and dezocine combination was superior to monotherapy for postoperative analgesia in patients with resectable NSCLC.
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Affiliation(s)
- Xiaona Wei
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Zhigang Wang
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Yongxue Chen
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Xiaowei Wang
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Long Ma
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Junde Hou
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
| | - Lu Zhao
- Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056008, P.R. China
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Squeo F, Celiberto F, Ierardi E, Russo F, Riezzo G, D’Attoma B, Leo AD, Losurdo G. Opioid-induced Constipation: Old and New Concepts in Diagnosis and Treatment. J Neurogastroenterol Motil 2024; 30:131-142. [PMID: 38576366 PMCID: PMC10999847 DOI: 10.5056/jnm23144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 04/06/2024] Open
Abstract
Daily use of opioid analgesics has significantly increased in recent years due to an increasing prevalence of conditions associated with chronic pain. Opioid-induced constipation (OIC) is one of the most common, under-recognized, and under-treated side effects of opioid analgesics. OIC significantly reduces the quality of life by causing psychological distress, lowering work productivity, and increasing access to healthcare facilities. The economic and social burden of OIC led to the development of precise strategies for daily clinical practice. Key aspects are the prevention of constipation through adequate water intake and fiber support, avoidance of sedentariness, and early recognition and treatment of cofactors that could worsen constipation. Recommended first-line therapy includes osmotic (preferably polyethylene glycol) and stimulant laxatives. Peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, naloxegol, or naldemedine, should be used in patients that have not responded to the first-line treatments. The bowel functional index is the main tool for assessing the severity of OIC and for monitoring the response. The paper discusses the recent literature on the pathophysiology, clinical evaluation, and management of OIC and provides a pragmatic approach for its assessment and treatment.
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Affiliation(s)
- Francesco Squeo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
- PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision Medicine Jonic Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Russo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Giuseppe Riezzo
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Benedetta D’Attoma
- Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, Castellana Grotte, Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
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Tradounsky GE. Gastro-Intestinal Symptoms in Palliative Care Patients. Curr Oncol 2024; 31:2341-2352. [PMID: 38668077 PMCID: PMC11049445 DOI: 10.3390/curroncol31040174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients' quality of life (QOL) and should be treated as quickly and aggressively as possible.
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Affiliation(s)
- Golda Elisa Tradounsky
- Palliative Care Services, Mount Sinai Hospital, CIUSSS West Central of the Island of Montreal, 5690 Cavendish Blvd, Côte Saint-Luc, QC H4W 1S7, Canada;
- Department of Family Medicine, McGill University, Montréal, QC H3S 1Z1, Canada
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Yamamoto Y, Yamamoto S, Tsuge T, Urano K, Matsuura K. Analysis of Nausea and Vomiting Frequency Following Opioid Dose Escalation and Its Risk Factors: A Single-Center Retrospective Observational Study. J Palliat Med 2024; 27:301-306. [PMID: 37733255 DOI: 10.1089/jpm.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background and Objective: Opioid-induced nausea and vomiting (OINV) is known to develop not only upon opioid introduction but also during opioid dose escalation, but the actual details are unclear. The aim of this study was to investigate the frequency of OINV in opioid dose escalation at a single center and to identify risk factors. Methods: A retrospective analysis of the medical records of hospitalized patients with cancer who underwent increased intake of oral oxycodone extended-release tablets at Komaki City Hospital between January 2016 and December 2019 was performed. Associations between the incidence of OINV and multiple factors were analyzed, including patient demographics, opioid daily dose, comorbidities, history of nausea after opioid introduction, and prophylactic antiemetic drugs. Results: Of the 132 patients analyzed, 56 (42.4%; grades 1 and 2, 36 and 20, respectively) developed opioid-induced nausea after opioid dose escalation, 26 (19.7%; grades 1 and 2, 19 and 7, respectively) developed opioid-induced vomiting, 58 (43.9%) had either opioid-induced nausea or vomiting. Thirty-five of 60 patients (55.0%) developed OINV among those who received prophylactic antiemetic drugs at opioid dose escalation. Performance status (≥2) (odds ratio [OR]: 2.36, 95% confidence interval [95% CI]: 1.15-4.84, p = 0.02) and history of nausea for opioid introduction (OR: 2.92, 95% CI: 1.20-7.10, p = 0.02) were detected as risk factors for the development of OINV. Conclusion: This study revealed a high incidence of OINV during opioid dose escalation, indicating that careful monitoring is required as at the time of opioid introduction. Further validation by a prospective study is required.
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Affiliation(s)
| | - Seiji Yamamoto
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Taiga Tsuge
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
- Department of Pharmacy, Ena Hospital, Ena, Gifu, Japan
| | - Kimihiko Urano
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
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Serra J, Alcedo J, Barber C, Ciriza de Los Ríos C. Review document of the Spanish Association of Neurogastroenterology and Motility on the management of opioid-induced constipation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38305669 DOI: 10.17235/reed.2024.10242/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Opioid induced constipation is a rising problem due to the progressive increment in the prescription of opioids. By contrast to functional constipation, opioid-induced constipation is not a functional gut disorder, but a side effect of the use of opioids. Opioids produce constipation due to a decrease in gastrointestinal motility and a reduction in the gastrointestinal secretions. The treatment of OIC focuses on three basic pillars: optimizing opioid drug indication, preventing constipation onset, and treating it if it occurs. As with any other cause of constipation, lifestyle adjustments and laxatives should be the first-line treatment in the pharmacological management of OIC. Osmotic laxatives such as polyethylene glycol (PEG) are the agents of choice. PEG is inert and is neither fermented nor absorbed in the gastrointestinal tract. Furthermore, it has broad clinical applicability due to its favourable safety profile. If first-line treatments fail, peripheral mu receptor antagonists (PAMORA) are the drugs of choice. They reduce the peripheral effects of OIC with minimal potential to diminish analgesia or induce centrally mediated withdrawal syndrome. Different PAMORA are available in the market, both for oral and subcutaneous administration, with demonstrated efficacy for management of OIC in different clinical trials.
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Affiliation(s)
- Jordi Serra
- Digestive System Research Unit, Hospital Universitari Vall d'Hebron, España
| | - Javier Alcedo
- Gastroenterology, Hospital Universitario Miguel Servet, España
| | - Claudia Barber
- Digestive System Research Unit, Hospital Universitari Vall d'Hebron, España
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Shanholtz G, Vergara FH, Amba KT, Ramos MD. Bowel Management Protocol: Impact on Care Transitions of Oncology Patients. Prof Case Manag 2024; 29:22-29. [PMID: 37983778 DOI: 10.1097/ncm.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
PURPOSE OF STUDY The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS). PRIMARY PRACTICE OF SETTING Oncology unit in a community hospital. METHODOLOGY AND SAMPLE A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS. RESULTS Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001). IMPLICATIONS TO CASE MANAGEMENT PRACTICE Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.
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Affiliation(s)
- Gayle Shanholtz
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Franz Henryk Vergara
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Katheryne Tifuh Amba
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Mary Dioise Ramos
- Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia
- Franz Henryk Vergara, PhD, DNP, RN, CENP, CCM, ONC, was the doctoral capstone chairman and he was the supervising faculty of Dr. Shanholtz. Currently, Dr. Vergara is a principal consultant at Nurse Atbp LLC, Columbia, Maryland
- Katheryne Tifuh Amba, PhD, DNP, RN, ACNP-BC, CCRN, is nurse scientist at SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
- Mary Dioise Ramos, PhD, RN, is associate professor at WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
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7
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Ioannou A, Costanzini A, Giancola F, Cabanillas L, Lungaro L, Manza F, Guarino M, Arena R, Caio G, Torresan F, Polydorou A, Vezakis A, Karamanolis G, Sternini C, De Giorgio R. Chronic constipation in Parkinson's disease: clinical features and molecular insights on the intestinal epithelial barrier. Ann Gastroenterol 2024; 37:22-30. [PMID: 38223240 PMCID: PMC10785021 DOI: 10.20524/aog.2023.0851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/12/2023] [Indexed: 01/16/2024] Open
Abstract
Background Chronic constipation (CC) is a severe symptom in Parkinson's disease (PD), with an unclear pathogenesis. Abnormalities of the enteric nervous system (ENS) and/or intestinal epithelial barrier (IEB) may be pathophysiologically relevant in PD patients with CC. We investigated possible molecular changes of the IEB in PD/CCs compared with CCs and controls. Methods Twelve PD/CCs (2 female, age range 51-80 years), 20 CCs (15 female, age range 27-78 years), and 23 controls (11 female, age range 32-74 years) were enrolled. Ten PD/CCs and 10 CCs were functionally characterized by anorectal manometry (AM) and transit time (TT). Colon biopsies were obtained and assessed for gene and protein expression, and localization of IEB tight junction markers claudin-4 (CLDN4), occludin-1 (OCCL-1), and zonula occludens-1 (ZO-1) by RT-qPCR, immunoblot and immunofluorescence labeling. Results PD/CCs were clustered in 2 functional categories: patients with delayed TT and altered AM (60%), and a second group showing only modifications in AM pattern (40%). Gene expression of CLDN4, OCCL-1 and ZO-1 was higher in PD/CCs than controls (P<0.05). Conversely, PD/CCs showed a trend to decrease (P>0.05) in CLDN4 and OCCL-1 protein levels than controls, whereas ZO-1 protein was comparable. In PD/CCs compared with controls, decreasing tendency of vasoactive intestinal polypeptide mRNA, protein and immunoreactive fiber density were observed, although the difference was not statistically significant. Conclusion Transit and anorectal dysfunctions in PD/CCs are associated with difference in ZO-1, OCCL-1 and CLDN4 expression, thus supporting the role of an altered IEB as a contributory mechanism to possible neuronal abnormalities.
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Affiliation(s)
- Alexandros Ioannou
- Gastroenterology Department, “Alexandra” General
Hospital of Athens, Greece (Alexandros Ioannou)
| | - Anna Costanzini
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
| | - Fiorella Giancola
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico
di Sant’Orsola-Malpighi, Bologna, Italy (Fiorella Giancola)
| | - Luis Cabanillas
- Division of Digestive Diseases, Departments Medicine and
Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, USA (Luis Cabanillas,
Catia Sternini)
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
| | - Francesca Manza
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
| | - Rosario Arena
- Gastroenterology and Digestive Endoscopy O.U., Azienda
Ospedaliero-Universitaria di Ferrara, Italy (Rosario Arena)
| | - Giacomo Caio
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
- Mucosal Immunology and Biology Research Center, Massachusetts
General Hospital-Harvard Medical School, Boston, USA (Giacomo Caio)
| | - Francesco Torresan
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria
di Bologna Policlinico di Sant’Orsola-Malpighi, Bologna, Italy (Francesco
Torresan)
| | - Andreas Polydorou
- Department of Surgery, Aretaieion University Hospital, National
and Kapodistrian University of Athens, Greece (Andreas Polydorou, Antonios Vezakis)
| | - Antonios Vezakis
- Department of Surgery, Aretaieion University Hospital, National
and Kapodistrian University of Athens, Greece (Andreas Polydorou, Antonios Vezakis)
| | - George Karamanolis
- Gastroenterology Unit, Second Department of Surgery, Aretaieion
University Hospital, School of Medicine, National and Kapodistrian University of Athens,
Greece (George Karamanolis)
| | - Catia Sternini
- Division of Digestive Diseases, Departments Medicine and
Neurobiology, David Geffen School of Medicine, UCLA, Los Angeles, USA (Luis Cabanillas,
Catia Sternini)
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara,
Italy (Anna Costanzini, Lisa Lungaro, Francesca Manza, Matteo Guarino, Giacomo Caio, Roberto
De Giorgio)
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Calsina-Berna A, González-Barboteo J, Llorens-Torromé S, Julià-Torras J. Antitumoral Agent-Induced Constipation: A Systematic Review. Cancers (Basel) 2023; 16:99. [PMID: 38201526 PMCID: PMC10778329 DOI: 10.3390/cancers16010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Constipation is a common symptom in patients receiving antitumoral treatment. The mechanisms underlying antitumoral agent-induced constipation (ATAIC) are poorly defined. This systematic review aimed to analyze and synthesize the available information related to the prevalence, etiology, and treatment of ATAIC. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. The review included human studies written in English, French, or Spanish involving patients with cancer and containing information about the prevalence, etiology, and treatment of ATAIC. RESULTS A total of 73 articles were included. The reported prevalence ranged from 0.8% to 86.6%. Six studies reported an ATAIC prevalence of over 50%. The prevalence rates of constipation of grades 3 and 4 ranged between 0 and 11%. The importance of enteric neuronal integrity in gastrointestinal function was reported. The articles with the highest levels of evidence in relation to ATAIC treatment obtained in this systematic review studied treatments with acupuncture, sweet potato, osteopath, probiotics, and moxibustion. CONCLUSIONS The prevalence of constipation in patients undergoing antitumoral treatment is very diverse. Studies specifically designed to report the prevalence of antineoplastic treatment-induced constipation are needed. The importance of enteric neuronal integrity in gastrointestinal function was described. Thus, neuroprotection could be an area of research for the treatment of chemotherapy-induced gastrointestinal disorders.
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Affiliation(s)
- Agnès Calsina-Berna
- Palliative Care Department, School of Medicine, The University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
- Palliative Care Department, Institut Català d'Oncologia, 08908 Badalona, Spain
- Research and Knowledge Group in Palliative Care of Catalan Institute of Oncology (GRICOPAL), 08916 Badalona, Spain
| | - Jesús González-Barboteo
- Research and Knowledge Group in Palliative Care of Catalan Institute of Oncology (GRICOPAL), 08916 Badalona, Spain
- Palliative Care Department, Institut Català d'Oncologia-L'Hospitalet, 08916 Badalona, Spain
| | - Silvia Llorens-Torromé
- Research and Knowledge Group in Palliative Care of Catalan Institute of Oncology (GRICOPAL), 08916 Badalona, Spain
- Palliative Care Department, Institut Català d'Oncologia-L'Hospitalet, 08916 Badalona, Spain
| | - Joaquim Julià-Torras
- Palliative Care Department, Institut Català d'Oncologia, 08908 Badalona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
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9
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Guo F, Sun Z, Wang Z, Gao J, Pan J, Zhang Q, Ren S. Nomogram for predicting prolonged postoperative ileus after laparoscopic low anterior resection for rectal cancer. World J Surg Oncol 2023; 21:380. [PMID: 38082330 PMCID: PMC10712154 DOI: 10.1186/s12957-023-03265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is a common complication after colorectal surgery that increases patient discomfort, hospital stay, and financial burden. However, predictive tools to assess the risk of PPOI in patients undergoing laparoscopic low anterior resection have not been developed. Thus, the purpose of this study was to develop a nomogram to predict PPOI after laparoscopic low anterior resection for rectal cancer. METHODS A total of 548 consecutive patients who underwent laparoscopic low anterior resection for mid-low rectal cancer at a single tertiary medical center were retrospectively enrolled between January 2019 and January 2023. Univariate and multivariate logistic regression analysis was performed to analyze potential predictors of PPOI. The nomogram was constructed using the filtered variables and internally verified by bootstrap resampling. Model performance was evaluated by receiver operating characteristic curve and calibration curve, and the clinical usefulness was evaluated by the decision curve. RESULTS Among 548 consecutive patients, 72 patients (13.1%) presented with PPOI. Multivariate logistic analysis showed that advantage age, hypoalbuminemia, high surgical difficulty, and postoperative use of opioid analgesic were independent prognostic factors for PPOI. These variables were used to construct the nomogram model to predict PPOI. Internal validation, conducted through bootstrap resampling, confirmed the great discrimination of the nomogram with an area under the curve of 0.738 (95%CI 0.736-0.741). CONCLUSIONS We created a novel nomogram for predicting PPOI after laparoscopic low anterior resection. This nomogram can assist surgeons in identifying patients at a heightened risk of PPOI.
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Affiliation(s)
- Fangliang Guo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Zhiwei Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Zongheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Jianfeng Gao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China
| | - Jiahao Pan
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, 200003, People's Republic of China
| | - Qianshi Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China.
| | - Shuangyi Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116023, People's Republic of China.
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10
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Wang YY, Fu HJ. Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer. World J Gastrointest Surg 2023; 15:2171-2178. [PMID: 37969718 PMCID: PMC10642456 DOI: 10.4240/wjgs.v15.i10.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy. AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block (TAPB) in gastric cancer patients undergoing laparoscopic radical gastrectomy. METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group (n = 45) and epidural anesthesia group (n = 40) according to the different anesthesia and analgesia programs used. The TAPB group received general anesthesia combined with TAPB, and the epidural anesthesia group received general anesthesia combined with epidural anesthesia. The pain status, cognitive status, intestinal barrier indicators, recovery quality, and incidence of complications were compared between the two groups. RESULTS Compared with the epidural anesthesia group, the TAPB group's visual analog scale scores were significantly lower 6 h, 12 h, 24 h and 48 h after surgery (P < 0.05). The incidence of postoperative cognitive dysfunction (POCD) in the TAPB group was significantly lower than that in the epidural anesthesia group, and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group (P < 0.05). The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery (P < 0.05). The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group (P < 0.05). The total incidence of postoperative complications in the TAPB group was 4.44%, significantly lower than the 20.00% in the epidural anesthesia group (P < 0.05). CONCLUSION Compared with epidural anesthesia combined with general anesthesia, TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications, improve the levels of intestinal barrier indicators, and improve postoperative recovery quality.
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Affiliation(s)
- Ya-Ya Wang
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
| | - Hua-Jun Fu
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
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11
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Naya N, Oka H, Hashimoto S, Morioka Y, Kizawa Y. Real-World Evidence for the Safety and Effectiveness of Naldemedine in the Management of Opioid-Induced Constipation in Patients With Cancer Pain: Post-hoc Subgroup Analysis of Post-marketing Surveillance in Japan. Cureus 2023; 15:e46090. [PMID: 37900431 PMCID: PMC10611588 DOI: 10.7759/cureus.46090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Opioid-induced constipation is common and greatly affects the quality of life but is often under-recognised and undertreated. This study aimed to investigate the safety and effectiveness of naldemedine for opioid-induced constipation with cancer pain according to specific subgroups of clinical interest. METHODS In this exploratory post-hoc subgroup analysis of post-marketing surveillance from Japan (UMIN: 000042851), data were investigated by the subgroups: age (≥75, <75 years), Eastern Cooperative Oncology Group performance status (PS 0-2, 3-4), constipation severity (mild, moderate, severe), brain metastasis (yes, no), anticancer drug treatment (yes, no), opioid at naldemedine initiation (fentanyl only, only strong opioids other than fentanyl, weak opioids only, other), and prior or concomitant use of laxative (only osmotic/saline laxatives, only stimulant laxatives, other, none). Enrolled patients (n = 1184) received naldemedine (0.2 mg once daily) orally for up to 12 weeks. Regarding safety endpoints, the incidence of adverse drug reactions, including diarrhoea, was determined within each subgroup. Regarding effectiveness endpoints, improvement rates in the frequency and condition of bowel movements were investigated by subgroups. RESULTS The incidence of adverse drug reactions, including diarrhoea, among subgroups ranged from 7.74% to 16.08% (diarrhoea: 5.95% to 13.19%), compared to 11.30% (diarrhoea: 9.09%) in the total population. Through week two to week 12, improvement rates in the frequency and condition of bowel movement among subgroups ranged from 63.6% to 89.7% and 67.6% to 94.9%, compared to 75.0% to 83.2% and 80.0% to 88.0% in the total population, respectively. CONCLUSIONS Naldemedine was well tolerated and effective in patients with opioid-induced constipation and cancer pain regardless of the subgroups investigated.
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Affiliation(s)
- Noriyuki Naya
- Medical Affairs Department, Shionogi & Co. Ltd., Osaka, JPN
| | - Hiroaki Oka
- Pharmacovigilance Department, Shionogi & Co. Ltd., Osaka, JPN
| | - Sayo Hashimoto
- Pharmacovigilance Department, Shionogi & Co. Ltd., Osaka, JPN
| | | | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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12
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Di Nardo G, Zenzeri L, Guarino M, Molfino A, Parisi P, Barbara G, Stanghellini V, De Giorgio R. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17:325-341. [PMID: 36939480 DOI: 10.1080/17474124.2023.2193887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous and severe form of gastrointestinal dysmotility. AREAS COVERED Pertinent literature on pediatric and adult CIPO management has been assessed via PubMed, Scopus, and EMBASE from inception to June 2022. Prokinetics, aimed at restoring intestinal propulsion (e.g. orthopramides and substituted benzamides, acetyl cholinesterase inhibitors, serotonergic agents and others), have been poorly tested and the available data showed only partial efficacy. Moreover, some prokinetic agents (e.g. orthopramides and substituted benzamides) can cause major side effects. The CIPO-related small intestinal bacterial overgrowth requires treatment preferably via poorly absorbable antibiotics to avoid bacterial resistance. Apart from opioids, which worsen gut motility, analgesics should be considered to manage visceral pain, which might dominate the clinical manifestations. Nutritional support, via modified oral feeding, enteral or parenteral nutrition, is key to halt CIPO-related malnutrition. EXPERT OPINION There have been significant roadblocks preventing the development of CIPO treatment. Nonetheless, the considerable advancement in neurogastroenterology and pharmacological agents cast hopes to test the actual efficacy of new prokinetics via well-designed clinical trials. Adequate dietary strategies and supplementation remain of crucial importance. Taken together, novel pharmacological and nutritional options are expected to provide adequate treatments for these patients.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.,Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Alessio Molfino
- Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Barbara
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Vincenzo Stanghellini
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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13
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Mousavi T, Nikfar S, Abdollahi M. An update on the use of pharmacotherapy for opioid-induced bowel dysfunction. Expert Opin Pharmacother 2023; 24:359-375. [PMID: 36548911 DOI: 10.1080/14656566.2022.2161883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With the growing rate of aging and the incidence of chronic diseases, there has been an upsurge in opioid prescription and abuse worldwide. This has been associated with increased reports of opioid-related adverse events, particularly opioid-induced bowel dysfunction (OIBD), calling for a rational clinical management strategy. AREAS COVERED Through searching PubMed, Scopus, Cochrane Library, and Web of Science, English literature was gathered as of 1 January 2017. Furthermore, the USFDA, EMA, TGA, Clinicaltrials.Gov, WHO-ICTRP databases, and the latest guidelines were reviewed to extract ongoing clinical studies and provide an evidence-based expert opinion with detailed information on efficacy, safety, approval status, and pharmacokinetics of the currently used medications. EXPERT OPINION Despite the significant burden of OIBD, the clinical development of agents lags behind disease progress. Although in most places, management of opioid-induced constipation (OIC) is initiated by lifestyle modifications followed by laxatives, opioid antagonists, and secretagogue agents, there are still major conflicts among global guidelines. The fundamental reason is the lack of head-to-head clinical trials providing inter- and intragroup comparisons between PAMORAs, laxatives, and secretagogue agents. These investigations must be accompanied by further valid biopharmaceutical and economic evaluations, paving the way for rational clinical judgment in each context.
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Affiliation(s)
- Taraneh Mousavi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran, Iran.,Personalized Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
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14
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Li Y, Yu H, Xu B, Yuan F, Zhang P, Tu S, Zhou Y, Li X. Pharmacokinetics and Bioequivalence of the Lubiprostone Capsule in Healthy Chinese Subjects. Clin Pharmacol Drug Dev 2023; 12:436-446. [PMID: 36626291 DOI: 10.1002/cpdd.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/29/2022] [Indexed: 01/11/2023]
Abstract
A pharmacokinetic (PK) study and a bioequivalence (BE) study were conducted to investigate the PK characteristics and safety of lubiprostone in healthy Chinese subjects and to evaluate the BE between the test and the reference drugs. The PK study consisted of a fasting state cohort (a single dose of 24 µg of lubiprostone), a 2-period crossover fasting and fed state cohort (a single dose of 48 µg of lubiprostone), and a multiple-dose cohort (24 µg of lubiprostone twice daily). The BE study was a single-dose, 2-treatment, 4-period, replicated crossover study. The plasma concentration of 15-OH-lubiprostone (M3) was measured by high-performance liquid chromatography-tandem mass spectrometry. The PK parameters were calculated using the noncompartment model with Phoenix WinNonlin. After a single dose of 24 ug of lubiprostone, the main PK parameters of M3 were 49.2 pg/mL, 74.0 h/pg/mL, and 1.1 hours for maximum plasma concentration (Cmax ), area under the plasma concentration time curve from time 0 to the last time point, and t1/2 , respectively. The main PK parameters of M3 showed dose-proportional characteristics in the dose range of 24-48 µg. Food affects the PK parameters of M3. Compared to the fasting state, time to maximum plasma concentration was delayed, Cmax decreased slightly, while AUC increased significantly under the fed state. The test and reference products had similar PK parameters and were bioequivalent in the fed state.
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Affiliation(s)
- Yuan Li
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
| | - Haitao Yu
- Nanjing Chia Tai Tianqing Pharmaceutical Co., Ltd., Nanjing, Jiangsu, China
| | - Bing Xu
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
| | - Fang Yuan
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
| | - Ping Zhang
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
| | - Shengqing Tu
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
| | - Yumeng Zhou
- Nanjing Chia Tai Tianqing Pharmaceutical Co., Ltd., Nanjing, Jiangsu, China
| | - Xin Li
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, China
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15
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Abstract
Opioid-induced constipation (OIC) is a common condition in older adults who may not be responsive to traditional laxative therapy. OIC is defined as new or worsening constipation symptoms that occur with initiation of or altering the dose of opioid analgesia. For adult patients with OIC and noncancer pain, we recommend considering nonpharmacologic interventions (eg, dietary measures, increased physical activity, and biofeedback training) and over-the-counter laxatives, followed by prescription opioid receptor antagonists (methylnaltrexone, naloxegol, and naldemedine) if traditional over-the-counter laxatives fail. Other options may include lubiprostone, linaclotide, plecanatide, and prucalopride; however, these are not indicated for OIC specifically or studied in older adults. Because of the complex nature of absorption, distribution, metabolism, and excretion in the aging population, all agents used to treat OIC must be evaluated individually and reevaluated as patients continue to age. This review will serve as a guide to managing OIC in older adults.
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16
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Lu Z, Luo A, Min S, Dong H, Xiong Q, Li X, Deng Q, Liu T, Yang X, Li C, Zhao Q, Xiong L. Acupoint Stimulation for Enhanced Recovery After Colon Surgery: A Prospective Multicenter Randomized Controlled Trial. J Multidiscip Healthc 2022; 15:2871-2879. [PMID: 36570812 PMCID: PMC9785190 DOI: 10.2147/jmdh.s391852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in improving bowel function and thus shortening hospital stay after laparoscopic colon surgery within the ERAS pathway. Patients and Methods From November 2016 to March 2018, 100 patients who underwent elective colon surgery were enrolled and 94 finished study (n = 47 for each) in three university hospitals. Patients in the TEAS group received TEAS 30 min before surgery and once a day for 3 days after surgery, while those in the Control Group received no stimulation. Primary outcome was the time to discharge. Results Compared with standardized postoperative care, TEAS resulted in a shorter time to first flatus (P=0.03) and time to first defecation (P=0.03), as well as a reduction in the length of hospital stay (P=0.02). Median patient-controlled analgesia (PCA) deliveries and PCA attempts at 24h, 48h and 72h after surgery were less in the TEAS group (P<0.01). No evidence of significant advantages in postoperative pain intensity, nausea, vomiting, sleeping quality and expenses was found in the TEAS group. Conclusion Perioperative TEAS further shortens the time to meet discharge criteria after laparoscopic colon surgery in patients under ERAS strategy.
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Affiliation(s)
- Zhihong Lu
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China,Correspondence: Zhihong Lu; Lize Xiong, Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Changle West Road127, Xi’an, Shaanxi, 710032, People’s Republic of China, Tel +86-29-84775337; Tel +86-29-84772126, Email ;
| | - Ailin Luo
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Su Min
- Department of Anaesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hailong Dong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Qiuju Xiong
- Department of Anaesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xinhua Li
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Qingzhu Deng
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Tingting Liu
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Xue Yang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Chen Li
- Department of Medical Statistics, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Qingchuan Zhao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Lize Xiong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China,Translational Research Institute of Brain and Brain-Like Intelligence and Department of Anesthesiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, People’s Republic of China
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17
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Alnaeem MM, Ahmad M. Constipation Severity and Quality of Life among Patients with Cancer Who Received Prophylactic Laxatives: Quasi-Experimental Study. Asian Pac J Cancer Prev 2022; 23:3473-3480. [PMID: 36308373 PMCID: PMC9924347 DOI: 10.31557/apjcp.2022.23.10.3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Prophylactic laxatives were associated with decreasing the incidence of Opioid-induced constipation among patients with cancer. This study aims to evaluate the effectiveness of early prophylactic laxatives therapy on the severity of constipation and quality of life among patients with cancer receiving opioids. METHODS Using a quasi-experimental design with 64 patients assigned to control group and 66 patients assigned to intervention group. The final sample was composed from 112 patients (57 in control group and 55 in intervention group), who were selected from an oncology clinic. Patients in the intervention group have received prophylactical laxatives The intervention included an oral colonic stimulant laxative (i.e., Bisacodyl, Dose= 3 tab/ day and/or Senna 6.8 mg twice daily) and an oral colonic osmotic laxative (i.e., Lactulose, Dose = 15 ml three times per day). Patients in the control group continue to receive their routine care without laxatives. RESULTS Patients in the intervention group have reported a significant reduction in the severity of constipation symptoms at eight weeks post the intervention (p < 0.001). Furthermore, the patients in the intervention group have revealed a significant improvement in their quality of life (QoL) (p< 0.001). CONCLUSIONS Patients with cancer need to use the first line of laxatives as prophylactic alongside with opioids to minimize the severity of Opioid-induced constipation symptoms and to enhance the QoL.
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Affiliation(s)
- Mohammad Minwer Alnaeem
- Palliative Care and Pain Management, School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan.
| | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, the Universe of Jordan, Amman, Jordan. ,For Correspondence:
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18
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Kamali M, Bagheri-Nesami M, Ghaemian A, Moosazadeh M, Esmaeili-Ahangarkelai N, Ghasemi Charati F, Haghighat S. The Effect of Acupressure on Preventing Constipation in Patients with Acute Myocardial Infarction under Primary Percutaneous Coronary Intervention. Middle East J Dig Dis 2022; 14:422-430. [PMID: 37547499 PMCID: PMC10404096 DOI: 10.34172/mejdd.2022.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/07/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three groups (P<0.001). Conclusion: The results of the present study showed that patients with AMI in the intervention group had significant improvement in terms of stool consistency based on the Bristol stool scale. So, acupressure can be used as a nursing intervention in critical care units.
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Affiliation(s)
- Mahsa Kamali
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- World Federation of Acupuncture-Moxibustion Societies (WFAS), Beijing, China
| | - Ali Ghaemian
- Fellowship of Interventional Cardiology, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Noncommunicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Nadali Esmaeili-Ahangarkelai
- Head of Scientific Studies Institute of Nadali Esmaeili and Training and Studies of Acupuncture Center
- Member of Executive Committee of World Federation of Acupuncture- Moxibustion Societies (WFAS), Beijing, China
| | - Fahimeh Ghasemi Charati
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Surgical Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sahar Haghighat
- PhD Student in Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
- Master of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
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19
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Chen HY, Wang ZN, Zhang WY, Zhu T. Advances in the clinical application of oxycodone in the perioperative period. World J Clin Cases 2022; 10:5156-5164. [PMID: 35812649 PMCID: PMC9210879 DOI: 10.12998/wjcc.v10.i16.5156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/29/2022] [Accepted: 04/03/2022] [Indexed: 02/06/2023] Open
Abstract
To review the research progress of pure opioid receptor agonist oxycodone. The research progress of oxycodone in terms of pharmacokinetics, pharmacodynamics, adverse reactions, clinical application, combined medication and new progress in clinical application was summarized by referring to the literature. Oxycodone is a semi-synthetic thebaine derivative of opioid alkaloids, and is a pure opioid μ and κ receptor agonist. The main action sites are the central nervous system and visceral smooth muscle. Due to its advantages of low adverse reactions, good analgesic effects, and a wide range of safe doses, the drug has been widely used in the control of acute and chronic postoperative pain, as well as malignant and non-malignant pain. Since the end of the 20th century, researchers have begun to formulate antipyretic analgesics, opioid receptor agonists, opioid receptor antagonists, dopamine receptor antagonists and other drugs with oxycodone in different proportions to enhance the analgesic effect. At the same time, it can reduce the dosage of oxycodone and reduce its adverse reactions, so as to achieve the purpose of limiting opioid abuse. With the continuous research on the efficacy and safety of oxycodone in the perioperative period at home and abroad, oxycodone has become the only dual-opioid potent analgesic that can be used in clinical work.
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Affiliation(s)
- Hong-Yang Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zi-Ning Wang
- Department of Anesthesiology, West China School of Clinical Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Lugoboni F, Hall G, Banerji V. Impact of opioid-induced constipation on opioid substitution therapy management: the patient perspective. Drugs Context 2021; 10:dic-2021-7-2. [PMID: 34745271 PMCID: PMC8547547 DOI: 10.7573/dic.2021-7-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Although opioid-induced bowel dysfunction is a well-known and frequent adverse event correlated with opioids, it is scarcely investigated in patients on opioid substitution treatment (OST) and no standard of care is currently available for this population. We aimed to explore the opinion of patients on the impact of constipation on the management of OST and quality of life (QoL). Methods We performed a survey that was directed to opioid-dependent patients treated with OST and followed-up in a Service for Addiction Treatment in Italy. The questionnaire included questions about sociodemographic characteristics, the experience of constipation, general QoL, OST management, interference of opioid-induced constipation (OIC) with opioid management, the experience of OIC treatment in the health system, and risk factors for constipation. Results Constipation at the moment of the survey (n=105) was reported by 81% of patients and was the most frequent adverse event of OST; 73% of respondents reported at least one severe or very severe symptom of constipation in the last 2 weeks. OIC was reported to hinder adherence to OST by 33% of respondents and 38% of them felt that control of craving had been more difficult since initiation of constipation. Overall, 34% of patients interfered with their OST by changing the schedule on their own in an attempt to improve constipation. Patients were proactive in looking for a solution for constipation but reported poor help from the healthcare system. Conclusion Our patient-based survey suggests that careful and efficient management of constipation could increase adherence to OST and improve patient satisfaction and QoL.
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Affiliation(s)
- Fabio Lugoboni
- Addiction Unit, Verona University Hospital, Verona, Italy
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21
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Yan Y, Chen Y, Zhang X. The effect of opioids on gastrointestinal function in the ICU. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:370. [PMID: 34689805 PMCID: PMC8543814 DOI: 10.1186/s13054-021-03793-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 12/31/2022]
Abstract
Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.
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Affiliation(s)
- Yun Yan
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yu Chen
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
| | - Xijing Zhang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
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