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.

中文翻译：

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N-甲基纳曲酮（一种外周作用的阿片类药物受体拮抗剂）与接受机器人辅助根治性膀胱切除术的患者的临床结局之间的关联。

目的评估外周作用型阿片受体拮抗剂N-甲基纳曲酮对接受膀胱癌根治性膀胱切除术的患者术后恢复的影响。方法我们回顾性地回顾了在常规使用N-甲基纳曲酮之前（对照组）和术后（治疗组）由一名外科医生（KC）接受机器人辅助根治性膀胱切除术的患者。Kaplan-Meier曲线和对数秩检验用于量化肠胀气，排便和排出的时间。比较每日平均阿片类药物使用量，每日疼痛评估等级和严重疼痛发作（7-10 / 10）。两组之间还比较了与胃肠道相关的并发症，包括肠梗阻，呕吐和/或术后需要置入鼻胃管，以及再次入院30天。比较各组之间的费用捕获数据以分析成本影响。结果对照组和治疗组的29例患者均符合纳入标准。与不使用N-甲基纳曲酮的患者相比，接受N-甲基纳曲酮的患者的住院时间缩短了（中位4天vs. 7天，p <0.01）。然而，肠胀气和排便的时间相似。然而，在控制可能的混杂因素的多变量分析中，与使用N-甲基纳曲酮相关的住院时间的改善没有达到统计学显着性（p = 0.11）。N-甲基纳曲酮组减少了剧烈疼痛和胃肠道综合并发症的发生率（44.8％对10.3％，p <0.01）。住院时间的减少可为每位患者节省约10,500美元的费用。结论在这项研究中，N-甲基纳曲酮与住院时间减少，严重疼痛发作次数减少以及成本降低相关。这些结果为进一步研究提供了动力。