Users Online: 282 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 254-255

Peripherally acting opioid receptor antagonists in pediatric patients


Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India

Date of Web Publication16-Jul-2018

Correspondence Address:
Abhijit Nair
Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Centre, Road No. 10, Banjara Hills, Hyderabad
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_313_16

Rights and Permissions

How to cite this article:
Nair A. Peripherally acting opioid receptor antagonists in pediatric patients. J Anaesthesiol Clin Pharmacol 2018;34:254-5

How to cite this URL:
Nair A. Peripherally acting opioid receptor antagonists in pediatric patients. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2019 Nov 15];34:254-5. Available from: http://www.joacp.org/text.asp?2018/34/2/254/236675



Madam,

We read with great interest the original article published by Michelet et al. in the July–September issue of this journal.[1] The authors by their personal experience and analysis have elaborated in an extremely lucid way the factors affecting recovery of postoperative bowel function after pediatric laparoscopic surgery, both elective and emergencies. The authors identify the extent of surgery, complications due to surgery, emergency surgeries, postoperative morphine consumption, and the postoperative use of nonsteroidal antiinflammatory drugs along with paracetamol as the factors associated with time for recovery of bowel function.

The last two factors, i.e., reducing the use of morphine and using multimodal nonopioid-based analgesia are in the domain of the anesthesiologist. With this letter, we want to take the discussion a little further.

Reversing the effect of opioid can be a solution but using opioid antagonist naloxone will reverse the analgesia conferred due to μ-receptor agonism as it crosses blood–brain barrier. Due to this problem, peripherally acting opioid receptor antagonists were developed, viz., alvimopan and methylnaltrexone. Both the drugs do not cross blood–brain barrier and thus reverse the effect at the intestinal level. Alvimopan is an orally available, peripherally acting μ-receptor antagonist which is approved by US Food and Drug Administration for use after bowel surgeries. The number of doses is limited to 15, with the first dose of 12 mg to be administered preoperatively followed by 12 mg twice daily for 7 days. Risk Evaluation and Mitigation Strategy is implemented with the use of perioperative alvimopan due to the cardiovascular adverse effects associated with its chronic use seen in patients taking it for opioid-induced constipation.[2] Unfortunately, alvimopan is neither approved nor studied in pediatric patient population.

Like alvimopan, methylnaltrexone is a peripherally acting opioid receptor antagonist which is administered subcutaneously and studied extensively in opioid-induced constipation in cancer patients. It is used at a dose of 0.15 mg/kg and is administered subcutaneously till the constipation is relieved.[3] Unlike alvimopan, methylnaltrexone has been used effectively in pediatric patients (oncology and surgical patients) and has been found to be effective in relieving opioid-induced constipation.[4] It is used in the same dose as in adult patients. Other nonsurgical factors that needs to be addressed are electrolyte imbalance (optimum serum potassium and magnesium levels) and use of laxatives to facilitate bowel movement. Drugs such as neostigmine and lignocaine have also been used successfully in treating ileus/obstruction in pediatric patients but randomized and high-volume studies are lacking in the literature.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Michelet D, Andreu-Gallien J, Skhiri A, Bonnard A, Nivoche Y, Dahmani S. Factors affecting recovery of postoperative bowel function after pediatric laparoscopic surgery. J Anaesthesiol Clin Pharmacol 2016;32:369-75.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Kraft M, Maclaren R, Du W, Owens G. Alvimopan (Entereg) for the management of postoperative ileus in patient undergoing bowel resection. P T 2010;35:44-9.  Back to cited text no. 2
    
3.
Thomas J, Karver S, Cooney GA, Chamberlain BH, Watt CK, Slatkin NE, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 2008;358:2332-43.  Back to cited text no. 3
    
4.
Rodrigues A, Wong C, Mattiussi A, Alexander S, Lau S, Dupuis LL. Methylnaltrexone for opioid-induced constipation in pediatric oncology patients. Pediatr Blood Cancer 2013;60:1667-70.  Back to cited text no. 4
    
5.
Traut U, Brügger L, Kunz R, Pauli-Magnus C, Haug K, Bucher HC, et al. Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev 2008;1:CD004930.  Back to cited text no. 5
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed492    
    Printed17    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal