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    Opioid-induced delay in gastric emptying: a peripheral mechanism in humans.

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    Authors
    Murphy, D B
    Sutton, J A
    Prescott, L F
    Murphy, M B
    Affiliation
    Cork University Hospital, Wilton, Cork City, Ireland.
    Issue Date
    2012-02-03T15:14:58Z
    MeSH
    Acetaminophen/blood
    Adult
    Cross-Over Studies
    Double-Blind Method
    Female
    Gastric Emptying/*drug effects
    Humans
    Male
    Naltrexone/*analogs & derivatives/pharmacology
    Narcotic Antagonists/*pharmacology
    Narcotics/*adverse effects
    Quaternary Ammonium Compounds
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    Citation
    Anesthesiology. 1997 Oct;87(4):765-70.
    Journal
    Anesthesiology
    URI
    http://hdl.handle.net/10147/209203
    PubMed ID
    9357876
    Abstract
    BACKGROUND: Opioids delay gastric emptying, which in turn may increase the risk of vomiting and pulmonary aspiration. Naloxone reverses this opiate action on gastric emptying, but it is not known whether this effect in humans is mediated by central or peripheral opiate antagonism. The importance of peripheral opioid receptor antagonism in modulating opioid-induced delay in gastric emptying was evaluated using methylnaltrexone, a quaternary derivative of the opiate antagonist naltrexone, which does not cross the blood-brain barrier. METHODS: In a randomized, double-blind, crossover placebo-controlled study, 11 healthy volunteers were given either placebo (saline), 0.09 mg/kg morphine, or 0.09 mg/kg morphine plus 0.3 mg/kg methylnaltrexone on three separate occasions before ingesting 500 ml deionized water. The rate of gastric emptying was measured by two methods: a noninvasive epigastric bioimpedance technique and the acetaminophen absorption test. RESULTS: The epigastric bioimpedance technique was sufficiently sensitive to detect opioid-induced changes in the rate of gastric emptying. The mean +/- SD time taken for the gastric volume to decrease to 50% (t0.5) after placebo was 5.5 +/- 2.1 min. Morphine prolonged gastric emptying to (t0.5) of 21 +/- 9.0 min (P < 0.03). Methylnaltrexone given concomitantly with morphine reversed the morphine-induced delay in gastric emptying to a t0.5 of 7.4 +/- 3.0 (P < 0.04). Maximum concentrations and area under the concentration curve from 0 to 90 min of serum acetaminophen concentrations after morphine were significantly different from placebo and morphine administered concomitantly with methylnaltrexone (P < 0.05). No difference in maximum concentration or area under the concentration curve from 0 to 90 min was noted between placebo and methylnaltrexone coadministered with morphine. CONCLUSIONS: The attenuation of morphine-induced delay in gastric emptying by methylnaltrexone suggests that the opioid effect is mediated outside the central nervous system. Methylnaltrexone may have the potential to decrease the side effects of opioid medications, which are mediated peripherally, while maintaining the central analgesia effect of the opioid.
    Language
    eng
    ISSN
    0003-3022 (Print)
    0003-3022 (Linking)
    Collections
    Cork University Hospital

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