Opioid induced constipation management in orthopaedic and trauma patients: treatment and the potential of nurse-initiated management

Abstract

BackgroundOpioid analgesics treat moderate to severe pain with proven analgesic efficacy, although their use is associated with dose-limiting side effects, such as constipation. Orthopaedic and trauma patients are at high risk of developing opioid-induced constipation (OIC) due to reduced mobility and increased opioid requirements to manage prolonged pain after injury. ObjectivesTo examine the evidence base to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC and nurse-initiated management of OIC. MethodA review of the literature was undertaken. Databases were searched to identify studies on OIC, laxatives and nurse-initiated management. ResultsLaxatives do not address the underlying cause of OIC and there is currently insufficient evidence to guide clinicians on the most effective or tolerated laxative regimen for the management of OIC. The use of peripheral acting mu-opioid receptor antagonists (PAMORAs) could be considered in those for whom regular use of a combination of laxatives has not been sucessful, and nurses should take a broader role in the assessment of symptoms and response to treatment. ConclusionThe important balance between adequate analgesia and minimising OIC symptoms is an ongoing challenge for clinicians, and an area of patient care where nurses could be leading management.