title: The opioid component of delayed gastrointestinal recovery after bowel resection.
abstract: BACKGROUND
  Patients undergoing bowel resection or other major abdominal surgery experience a period of delayed gastrointestinal recovery associated with increased postoperative morbidity and longer hospital length of stay. Symptoms include nausea, vomiting, abdominal distension, bloating, pain, intolerance to solid or liquid food, and inability to pass stool or gas. The exact cause of delayed gastrointestinal recovery is not known, but several factors appear to play a central role, namely the neurogenic, hormonal, and inflammatory responses to surgery and the response to exogenous opioid analgesics and endogenous opioids.
  
  
  CONCLUSIONS
  Stimulation of opioid receptors localized to neurons of the enteric nervous system inhibits coordinated gastrointestinal motility and fluid absorption, thereby contributing to delayed gastrointestinal recovery and its associated symptoms. Given the central role of opioid analgesics in delayed gastrointestinal recovery, a range of opioid-sparing techniques and pharmacologic agents, including opioid receptor antagonists, have been developed to facilitate faster restoration of gastrointestinal function after bowel resection when used as part of a multimodal accelerated care pathway. This review discusses the etiology of opioid-induced gastrointestinal dysfunction as well as clinical approaches that have been evaluated in controlled clinical trials to reduce the opioid component of delayed gastrointestinal recovery.
authors.affiliation: Department of Surgery, Bend Memorial Clinic, 1501 NE Medical Center Dr, Bend, OR 97701, USA. tbeard@bendbroadband.com
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Beard
authors.forename: John B
authors.initials: JB
authors.lastname: Leslie
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nemeth
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D013505:Digestive System Surgical Procedures; D005767:Gastrointestinal Diseases / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D010149:Postoperative Pain / Q000188:drug therapy*; D020127:Recovery of Function / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid