Ancillary Effects of Oral Naloxegol (Movantik)

Opioids are the gold standard for postoperative pain management, but they have been shown to produce uncomfortable side effects such as urinary retention (an inability to completely empty the bladder), constipation and nausea/vomiting. Clinical evidence demonstrates that Naloxegol can safely and effectively block these undesirable side effects while maintaining the painkilling effects of opioids in outpatients suffering from opioid-induced constipation.

Inclusion criteria

• Provision of informed consent prior to any study specific procedures
• Female or male aged at least 18 years
• American Society of Anesthesiologists physical status 1-4;
• Scheduled for elective primary hip or knee surgery under spinal anesthesia;
• Expected to receive intravenous patient-controlled analgesia (IV PCA)
• Expected to have significant postoperative pain
• Negative pregnancy test

Exclusion criteria

• Severe hepatic impairment, with/or twice the upper normal levels of liver enzymes
• Severe renal impairment, or creatinine level > 2.0
• History of bladder cancer
• Patients receiving perioperative regional anesthesia blocks
• Presence of a sacral nerve stimulator
• Medications (anticholinergic agents such as antihistamines, phenothiazines, antidepressants, antipsychotics), conditions or comorbidity causing urinary retention
• Patient with requirement of urinary catheter insertion before or immediately post-surgery due to immobility
• Urinary Tract Infections and other urogenital comorbidity (incontinence, cysto-ureteric reflux, known bladder retention) or conditions which can cause urinary retention
• Severe peptic ulcer disease, diverticular disease, infiltrative gastrointestinal tract malignancies, or peritoneal metastases
• Patients with known or suspected disruption of blood brain barrier, which may include but not limited to: Alzheimer's disease, stroke, poliomyelitis, cerebral palsy, multiple sclerosis, spinal lesions, and Parkinson's disease
• Gastrointestinal obstruction/Gastrointestinal perforation
• Strong CYP3A4 inhibitors (some antibiotics, antifungals, protease inhibitors, and antidepressants), Strong CYP3A4 inducers, Other opioid antagonists
• Hypersensitivity to MOVANTIK (naloxegol) or any of its excipients