736

Abstract

Introduction: Trauma patients typically have numerous injuries that require the use of opioid narcotics to control pain. The repeated use of these agents has been associated with decreased bowel motility which leads to a lack of bowel movements and constipation. There have been several agents used to try and combat opioid induced constipation. This study retrospectively evaluates the use of two specific enteral regimens: senna and docusate or naloxone and docusate. Methods: This is a retrospective review of patients admitted to the surgical-trauma intensive care unit (STICU) at CAMC General Division in Charleston, West Virginia between 1/1/2007 until 8/15/2012. All patients included in this analysis received enteral regimens of either naloxone and docusate or senna and docusate to facilitate bowel movements. Study endpoints included the number of days until the first bowel movement, the frequency of subsequent bowel movements, and toleration of tube feedings following initiation of the study medications. Additional assessments were made comparing opioid analgesic exposure between the study groups. Administered narcotic analgesics were converted to equipotent doses of morphine for the purpose of this comparison. Results: Seventy-seven patients were included in the study with 23 receiving naloxone and docusate and 54 receiving senna and docusate. Following the initiation of a bowel regimen the median length of time until the first bowel movement was 5 days in the naloxone and docusate arm and 2 days in the senna and docusate arm (p=0.01). The frequency of bowel movements also differed significantly between the study arms. The median number of bowel movements per week for patients receiving senna and docusate was 4 versus 1 in the naloxone and docusate arm (p=0.02). There were no differences seen in tube feed toleration between the study arms. A significant difference was seen in the amount of narcotic exposure between the study arms. Patients in the naloxone and docusate arm received a median amount of 188mg morphine exposure per day compared to 45mg for the senna and docusate arm (p=0.001). Conclusions: The use of senna and docusate was superior to naloxone and docusate at producing bowel movements in patients receiving continuous or scheduled opioid analgesics. Senna and docusate was also found to promote more frequent bowel movements in this patient population. Patients in the naloxone and docusate group were exposed to significantly larger daily doses of opioid narcotics which may have influenced the superior effects noted with senna and docusate.