@article{7c4c0ec142be450ebfa668db75c21fe5,
title = "Peripherally acting mu-opioid receptor antagonists and postoperative ileus: Mechanisms of action and clinical applicability",
abstract = "Postoperative ileus (POI), a transient cessation of coordinated bowel function after surgery, is an important health care problem. The etiology of POI is multifactorial and related to both the surgical and anesthetic pathways chosen. Opioids used to manage surgical pain can exacerbate POI, delaying gastrointestinal (GI) recovery. Peripherally acting mu-opioid receptor (PAM-OR) antagonists are designed to mitigate the deleterious effects of opioids on GI motility. This new class is investigational for POI management with the goal of accelerating the recovery of upper and lower GI tract function after bowel resection. In this review, we summarize the mechanisms by which POI occurs and the role of opioids and opioid receptors in the enteric nervous system, discuss the mechanism of action of PAM-OR antagonists, and review clinical pharmacology and Phase II/III POI trial results of methylnaltrexone and alvimopan. Finally, the role of anesthesiologists in managing POI in the context of a multimodal approach is discussed.",
author = "Viscusi, {Eugene R.} and Gan, {Tong J.} and Leslie, {John B.} and Foss, {Joseph F.} and Talon, {Mark D.} and Wei Du and Gay Owens",
note = "Funding Information: Dr. Viscusi received grant support from Adolor Corporation (alvimopan) and Progenics (methylnaltrexone) for the performance of clinical trials and is also a consultant for Adolor Corporation. Dr. Gan has received research support from Schering-Plough, MGI Pharma, Edwards Lifesciences, Wyeth Pharmaceuticals, Javelin, Aspect, and Hospira. He has served on the speakers bureaus for Edwards Lifesciences and Aspect Medical. Dr. Leslie received grants/research funding from Wyeth Pharmaceuticals and Progenics Pharmaceuticals and served as an advisor for Adolor Corporation, GlaxoSmithKline, Baxter Pharmaceuticals, Xsira, and Organon. Dr. Foss is a former employee of Adolor, holds patent rights to methylnaltrexone, and owns stock in Progenics. He currently receives research support from MGI Pharma. Mr. Talon has nothing to disclose. Dr. Du is a former employee of Adolor Corporation and has stock options. Dr. Owens is an employee of Adolor Corporation and has stock options. ",
year = "2009",
month = jun,
doi = "10.1213/ane.0b013e31819e0d3a",
language = "English (US)",
volume = "108",
pages = "1811--1822",
journal = "Anesthesia and analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "6",
}