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The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy

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Abstract

Purpose

To assess the impact of N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, on the post-operative recovery of patients undergoing robotic-assisted radical cystectomy for bladder cancer.

Methods

We retrospectively reviewed patients undergoing robotic-assisted radical cystectomy by a single surgeon (KC) prior to (control group) and after (treatment group) the routine use of N-methylnaltrexone. Kaplan–Meier curves and the log-rank test were used to quantify time to flatus, bowel movement, and discharge. Daily mean opioid use, daily pain assessment rating, and episodes of severe pain (7–10/10) were compared. Gastrointestinal-related complications, including ileus, emesis, and/or need for post-op nasogastric tube placement, and 30-day readmissions were also compared between groups. Charge capture data were compared between groups to analyze cost impact.

Results

29 patients each in the control and treatment group met inclusion criteria. Patients receiving N-methylnaltrexone had reduced length of stay compared with no N-methylnaltrexone (median 4 vs. 7 days, p < 0.01). Time to flatus and bowel movement, however, were similar. In a multivariable analysis controlling for possible confounders, however, the improvement in length of stay associated with N-methylnaltrexone use did not reach statistical significance (p = 0.11). Episodes of severe pain and composite gastrointestinal-related complications were reduced in the N-methylnaltrexone group (44.8% vs. 10.3%, p < 0.01). The reduction in length of stay was associated with approximately $10,500 in cost savings per patient.

Conclusions

In this study, N-methylnaltrexone was associated with reduced length of stay, fewer episodes of severe pain, and reduced costs. These results provide the impetus for further study.

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Funding

Funding to support this study was provided by Salix Pharmaceuticals (Bridgewater, NJ).

Author information

Authors and Affiliations

  1. Department of Urology, David Geffen School of Medicine At UCLA, 300 Stein Plaza, Suite 348, Los Angeles, CA, 90095, USA

    Andrew T. Lenis, Vishnukamal Golla, Patrick M. Lec, David C. Johnson, Izak Faiena & Karim Chamie

  2. Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Carol Lee & Siamak Rahman

  3. Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA

    Karim Chamie

Authors
  1. Andrew T. Lenis
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  2. Vishnukamal Golla
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  3. Patrick M. Lec
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  4. David C. Johnson
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  5. Izak Faiena
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  6. Carol Lee
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  7. Siamak Rahman
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  8. Karim Chamie
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Contributions

ATL: project development, data collection, data analysis, manuscript writing/editing. VG: project development, data collection, data analysis, manuscript writing/editing. PML: manuscript writing/editing. DCJ: manuscript writing/editing. IF: manuscript writing/editing. CL: manuscript writing/editing. SR: project development, manuscript editing. KC: project development, manuscript editing, data analysis.

Corresponding author

Correspondence to Karim Chamie.

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Conflict of interest

Karim Chamie, MD MSHS has received research grants from Salix Pharmaceuticals. The other authors have no conflicts of interest to declare.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Medical IRB, #18-001059) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was granted for this retrospective study after by the Institutional Review Board (Medical IRB, #18-001059).

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Lenis, A.T., Golla, V., Lec, P.M. et al. The association between N-methylnaltrexone, a peripherally acting mu-opioid receptor antagonist, and clinical outcomes in patients undergoing robotic-assisted radical cystectomy. World J Urol 38, 3113–3119 (2020). https://doi.org/10.1007/s00345-020-03117-y

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  • DOI: https://doi.org/10.1007/s00345-020-03117-y

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