Naloxegol and Postoperative Urinary Retention: A Randomized Trial.

Alparslan Turan,Daniel I Sessler,Steve Leung,Xuan Pu,Wael Ali Sakr Esa,Hassan Hamadnalla,Kurt Ruetzler,Jonathan Fang,John Seif,David Chelnick,Loran Mounir Soliman,Syed Raza

doi:10.3390/jcm11020454

Alparslan Turan, Daniel I Sessler + Show 10 more

Open Access

https://doi.org/10.3390/jcm11020454

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Abstract

Background: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo. Methods: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. Results: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. Conclusions: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.

Highlights

Published: 17 January 2022Post-operative urinary retention is a common postoperative complication, with an overall prevalence ranging from 2.1% to 70% depending on how the syndrome is defined and evaluated [1,2]
We found that urinary retention was common after hip and knee surgery and that residual urine volumes were high, especially on the first operative day
Another peripheral opioid antagonist methylnaltrexone was effective in nonsurgical volunteers in reversal of urinary retention supporting the theory that peripheral mechanisms play a role in opioid-induced urinary retention [18]

Summary

Introduction

Published: 17 January 2022Post-operative urinary retention is a common postoperative complication, with an overall prevalence ranging from 2.1% to 70% depending on how the syndrome is defined and evaluated [1,2]. Post-operative opioids are an established cause of post-operative urinary retention [5,6]. Consistent with this mechanism, naloxone frequently ameliorates urinary retention [7]. Naloxone antagonizes analgesia which limits its clinical utility. The drug antagonizes peripheral opioid receptors and opioid-related side effects without preventing opioid-related analgesia which is centrally mediated [8]. Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. The effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo.

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