The adverse effects of
opioids are well documented. Because
opioid receptors have a wide-ranging anatomic distribution, the effects subsequent to
opioid binding, both good and bad, occur centrally and in the periphery. Postoperative strategies to reduce
opioid burden, therefore, are in the patient's best interest. Multimodal
analgesia is the key towards balancing the need for
opioids while simultaneously reducing their burden. Alternative
anesthesia and analgesia options such as
regional anesthesia, nonsteroidal anti-inflammatory drugs, or
cyclooxygenase-2 enzyme inhibitors should be considered part of multimodal protocols. Familiarity of where these drugs are active in the body and how they can be employed is imperative for all surgical team members. Optimal implementation of multimodal approaches can reduce
hospital stay and improve clinical outcomes, including patient satisfaction. Finally, strategies that may help reduce rates of
hospital readmission also contribute to overall improved outcome. New peripherally acting
mu-opioid-receptor antagonists represent significant progress in the ability of perianesthesia nurses to play an even greater role in achieving these goals. In contrast to older
opioid-receptor antagonists, these agents specifically target an important aspect of the multifactorial etiology of postoperative
ileus (POI),
mu-opioid-receptor-mediated activity in the GI tract. In addition, they do not pass the blood-brain barrier or diminish
opioid-mediated
analgesia. Advanced clinical trials have already demonstrated the ability of one of these agents,
alvimopan, to reduce POI and improve other postoperative outcomes while maintaining adequate
analgesia. Combined with other options aimed at reducing
opioid burden,
alvimopan and similar drugs in development hold promise as part of multimodal protocols to optimize
pain management while minimizing postoperative morbidities.