title: The effect of methylnaltrexone on the side effects of intrathecal morphine after orthopedic surgery under spinal anesthesia.
abstract: Methylnaltrexone is a peripheral opioid receptor antagonist that does not cross the blood-brain barrier; so without interference with pain relief, it could reverse the peripheral opioid side effects such as constipation, pruritus, postoperative ileus, and urinary retention. This study has been designed to evaluate the effect of methylnaltrexone on postoperative side effects of intrathecal morphine. In seventy-two 18- to 55-year-old patients scheduled for elective orthopedic operations under spinal anesthesia, neuraxial blockade was achieved using 10 mg 0.5% hyperbaric bupivacaine and 0.1 mg preservative-free morphine sulfate. The first group (M) received 12 mg methylnaltrexone, while the second group (P) received normal saline, subcutaneously, immediately after spinal block in a randomized, double-blind fashion. There was a significant decrease in the rate of nausea and vomiting in group M, but there was no significant difference in the rate of pruritus or urinary retention between the two groups. Pain score was significantly lower in group M. Respiratory depression or decreased level of consciousness was not reported in any patient. Subcutaneous administration of methylnaltrexone was not effective in decreasing postoperative urinary retention and pruritus, but lowered the rate of nausea and vomiting and pain score after intrathecal bupivacaine and morphine.
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Zand
authors.forename: Afshin
authors.initials: A
authors.lastname: Amini
authors.forename: Saman
authors.initials: S
authors.lastname: Asadi
authors.forename: Arash
authors.initials: A
authors.lastname: Farbood
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D000644:Quaternary Ammonium Compounds; C032257:methylnaltrexone; D009271:Naltrexone; D009020:Morphine
keywords: PONV; intrathecal morphine; methylnaltrexone; pain score; postoperative nausea and vomiting; urinary retention