Pharmacological Treatment of Opioid-Induced Constipation Is Effective but Choice of Endpoints Affects the Therapeutic Gain

Effect of opioids on constipation in critically ill patients: A meta-analysis

OBJECTIVES

This meta-analysis evaluated the effect of opioids on constipation in ICU patients.

REVIEW METHOD USED

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang DATA databases.

REVIEW METHODS

Random or fixed-effects meta-analyses were used. Subgroup analysis was performed according to the definition of constipation (three vs. six days), opioids (fentanyl vs. morphine), study design (prospective vs. retrospective), adjustment of confounders (No vs. Yes), and patient's age (adults vs. children). We used sensitivity analysis to test the robustness of results with significant statistical heterogeneity.

RESULTS

Seven studies (2264 patients) were included. Opioid use in ICU patients was associated with an increased risk of constipation (relative risk [RR]=1.14; 95% confidence interval [CI]=1.05 to 1.24; I2=49.8%). Subgroup analysis further showed that adjustment form, category of opioid, study design, and patient's age significantly influenced the relationship between opioid use and the risk of constipation. Sensitivity analysis confirmed the robustness of pooled results.

CONCLUSION

Opioids significantly increase the risk of constipation in critically ill patients, especially children. It is worth noting that the adjustment of the constipation definition used for ICU significantly influenced the relationship between opioid use and the risk of constipation. Therefore, It is necessary to clearly define ICU constipation and conduct time-based layered treatment. Additional prospective studies are needed to investigate the consistent definition of ICU constipation.

Pharmacological and non-pharmacological treatments for opioid-induced constipation: A protocol for systematic review and network meta-analysis

BACKGROUND

Pain is very common and its management with a huge burden for patients and the healthcare system. And the network meta-analysis was designed to provide reference for the clinical practice.

METHODS

PubMed, EMBASE, Cochrane library, CNKI, VIP, Wan Fang, and CBM will be systematically searched their inception to November 2018. Randomized controlled trials that compared the effect of differently pharmacological or non-pharmacological treatments for opioid-induced constipation will be included. The primary outcome is the efficacy of therapeutic regimens. Risk of bias assessment of the included studies will be performed using the Cochrane risk of bias tool. A network meta-analysis will be performed using STATA 13.0 software with WinBUGS 1.4.3 software. Grading of Recommendations Assessment, Development, and Evaluation will be used to assess the overall quality of evidence.

RESULTS

This study is ongoing and will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide a comprehensive evidence on the effectiveness and safety of pharmacological and non-pharmacological treatments for opioid-induced constipation.

PROSPERO REGISTRATION NUMBER

CRD42018116533.