Naloxegol and Postoperative Urinary Retention: A Randomized Trial

Area of Science:

• Anesthesiology and Pain Management
• Pharmacology
• Urology

Background:

• Naloxegol is known to counteract opioid-induced side effects without affecting analgesia.
• The impact of naloxegol on opioid-induced bladder dysfunction is not well-established.
• Postoperative urinary retention is a common complication following major orthopedic surgery.

Purpose of the Study:

• To investigate the efficacy of naloxegol in mitigating opioid-induced urinary retention after hip and knee surgery.
• To determine if naloxegol administration affects residual bladder urine volume postoperatively.
• To assess secondary outcomes including opioid-related symptom distress and quality of recovery.

Main Methods:

• A randomized, placebo-controlled trial involving 136 patients undergoing elective hip or knee surgery.
• Patients received oral naloxegol or placebo on the day of surgery and the first two postoperative mornings.
• Residual urine volume was measured via ultrasonography; Opioid-related Symptom Distress Scale (ORSDS) and Quality of Recovery (QoR) scores were secondary outcomes.

Main Results:

• No significant difference was observed in residual urine volume between the naloxegol and placebo groups (p=0.84).
• Naloxegol administration was associated with a higher incidence of indwelling urinary catheterization (29% vs 11%, p=0.012).
• There were no statistically significant differences in ORSDS or QoR scores between the groups.

Conclusions:

• Naloxegol is not effective in treating or preventing postoperative urinary retention in patients undergoing hip and knee surgery.
• The findings do not support the use of naloxegol for managing urinary retention in this patient population.
• Further research may be needed to explore alternative pharmacologic interventions for opioid-induced bladder dysfunction.