Naloxone efficacy in bladder rehabilitation of spinal cord injury patients.
Naloxone has been reported to facilitate detrusor activity by blocking the inhibitory action of the enkephalins. We tested the urodynamic effects of intravenous naloxone (0.4 to 0.8 mg.) in 15 patients with spinal cord injury via rapid fill carbon dioxide cystometry and perineal electromyography. Fourteen patients had suprasacral lesions (3 complete), while 1 had an incomplete lower cord lesion. The average interval from injury was 4.2 months. Most of the patients were managed with intermittent catheterization and most had chronic bacteriuria. Initially, 10 patients had detrusor areflexia and 5 had detrusor hyperreflexia (2 with dyssynergia). Of the 15 patients 14 had no neuropathic condition as noted on baseline electromyography. After naloxone injection no significant cystometrographic changes occurred but 11 patients (73 per cent) had decreased electromyographic activity. The vesicourethral pattern of the 2 patients with dyssynergia did not change after naloxone, even though the electromyographic response decreased in both. The patients showed no other effects of the naloxone administration. Contrary to other studies, naloxone seemed to diminish pelvic floor (electromyographic) activity but it did not change bladder (cystometrographic) function during bladder rehabilitation of spinal cord injury patients.
D000328:Adult; D000368:Aged; D004576:Electromyography; D004745:Enkephalins / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D011312:Pressure; D013119:Spinal Cord Injuries / Q000150:complications*; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D014546:Urinary Catheterization; D014563:Urodynamics / Q000187:drug effects
D004745:Enkephalins; D009270:Naloxone