1
|
Ortega G, Lisenby A, Getz T, Zhang W, Mueller K, Schenker ML, Axson SA, Giordano NA. Opioid-Induced Constipation and Associated Symptoms After Orthopedic Trauma. Pain Manag Nurs 2024:S1524-9042(24)00198-X. [PMID: 39097419 DOI: 10.1016/j.pmn.2024.06.012] [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: 12/22/2023] [Revised: 03/19/2024] [Accepted: 06/14/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Opioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury. DESIGN Secondary analysis of 86 clinical trial participants following orthopedic trauma. METHODS Participants were assessed 2-weeks postoperatively with the following measures: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, past 24-hour average pain intensity captured on the numeric pain rating scale, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Linear regressions examined the association between PAC-SYM scores and both pain intensity and PROMIS T-scores while accounting for injury severity and opioid medication dosage. RESULTS Most participants (69%) reported experiencing opioid-induced constipation symptoms and 7% reported moderate to severe symptoms. Compared to those without symptoms, participants reporting opioid-induced constipation symptoms were found to have a 3-point increase in PROMIS Pain Interference (95% Confidence Interval [CI]: 0.28-5.90; p = .032), a 3-point decline in PROMIS Physical Function (95% CI: -6.57 to -0.02; p = .049), and a 1.7-point increase in average pain scores (95% CI: 0.50-3.01; p = .007) at 2-weeks following surgery. CONCLUSIONS Opioid-induced constipation symptoms are common after orthopedic trauma and linked to increased pain interference and pain intensity as well as reduced physical function. CLINICAL IMPLICATIONS Nurse-led assessments of opioid-induced constipation can support the timely delivery of interventions to alleviate symptoms and potentially improve patient-reported outcomes after injury.
Collapse
Affiliation(s)
- Gabriela Ortega
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Alexa Lisenby
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Tatiana Getz
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Kenneth Mueller
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Mara L Schenker
- School of Medicine, Emory University, Atlanta, Georgia; Grady Memorial Hospital, Atlanta, Georgia
| | - Sydney A Axson
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, State College, Pennsylvania
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
| |
Collapse
|
2
|
Gonzalez K, Sanchez K, Mauch K, Burchill CN, Bena JF, Morrison SL, Distelhorst KS. Efficacy of One Dose of Laxative on Postoperative Constipation Following Total Knee Arthroplasty. Orthop Nurs 2023; 42:304-309. [PMID: 37708528 DOI: 10.1097/nor.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Postoperative constipation is a common problem among orthopaedic surgical patients leading to discomfort, increased length of stay, and other complications. The primary purpose of this study was to determine the effectiveness of polyethylene glycol compared with docusate sodium for the prevention of constipation, after total knee arthroplasty. The secondary purpose was to examine the effectiveness of polyethylene glycol on pain and strain with bowel movement. A two-group nonequivalent cohort design was used to evaluate the effect of one 17-g dose of polyethylene glycol by mouth on postoperative day 1 compared with usual care with docusate sodium 100 mg starting the day of surgery and continued twice daily at home. There was no significant difference in the rate of constipation between the two cohorts in the 3 days after surgery. There was no difference in reported pain and strain. Future research should focus on the use of pharmacologic and nursing interventions together for prevention of postoperative constipation in patients with arthroplasty surgery.
Collapse
Affiliation(s)
- Kathleen Gonzalez
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - Karen Sanchez
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - Katelyn Mauch
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - Christian N Burchill
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - James F Bena
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - Shannon L Morrison
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| | - Karen S Distelhorst
- Kathleen Gonzalez, DNP, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Karen Sanchez, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Katelyn Mauch, MBA, BSN, RN, Cleveland Clinic Lutheran Hospital, Cleveland, OH
- Christian N. Burchill, PhD, MSN, RN, CEN, Cleveland Clinic, Cleveland, OH; Penn Medicine Lancaster General Hospital, Lancaster, PA
- James F. Bena, MS, Cleveland Clinic, Cleveland, OH
- Shannon L. Morrison, MS, Cleveland Clinic, Cleveland, OH
- Karen S. Distelhorst, PhD, APRN, GCNS-BC, Cleveland Clinic, Cleveland, OH
| |
Collapse
|