Oxycodone and macrogol 3350 treatment reduces anal sphincter relaxation compared to combined oxycodone and naloxone tablets

2017 ◽  
Vol 16 (1) ◽  
pp. 179-179
Author(s):  
Jakob Lykke Poulsen ◽  
Christina Brock ◽  
Debbie Grønlund ◽  
Klaus Krogh ◽  
Asbjørn Mohr Drewes
Keyword(s):  
Anal Canal ◽  
Anal Sphincter ◽  
Bowel Dysfunction ◽  
Stool Consistency ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
Rectoanal Inhibitory Reflex ◽  
Resting Pressure ◽  
Anal Resting Pressure ◽  
Inhibitory Reflex

Abstract Background Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction. However, it is unknown if the inhibition can be reduced by opioid antagonism with oral naloxone, and how this compares to osmotic laxative treatment. Aims To compare the effects of oxycodone and macrogol 3350 treatment (OX + PEG) versus combined oral oxycodone and naloxone (OXN) on anal sphincter function and gastrointestinal symptoms. Methods A randomised, double-blind, crossover trial was conducted in 20 healthy, male volunteers. Participants were randomised to five days treatment of OX + PEG or OXN. Anal resting pressure, anal canal distensibility, and rectoanal inhibitory reflex-induced sphincter relaxation were evaluated at baseline and on day 5. The Patient Assessment of Constipation questionnaire (PAC-SYM), stool frequency, and stool consistency were assed daily. Results Sphincter relaxation was reduced after OX + PEG treatment compared to OXN (difference = −17.6% [95% Cl;−25.2, −10.2]; P < 0.001). Anal resting pressure and anal canal distensibility did not differ between the treatments. PAC-SYM abdominal symptom subscale increased during OX + PEG compared to OXN (cumulated score: 3.2±2.3 vs. 0.2±1.8; P =0.002). Number of bowel movements was higher during OX + PEG vs. OXN (5.4±1.5 vs. 4.2±1.2; P = 0.035), but there was no difference in stool consistency (3.5±0.5 vs. 3.2±0.4; P = 0.14). Conclusions Sphincter relaxation was significantly reduced after OX + PEG compared to OXN. Evaluation of the rectoanal inhibitory reflex may serve as an important objective measure in future trials on treatment of opioid-induced bowel dysfunction.

The impact of naloxegol on anal sphincter function - Using a human experimental model of opioid-induced bowel dysfunction

2018 ◽  
Vol 117 ◽  
pp. 187-192 ◽  
Author(s):  
Debbie Grønlund ◽  
Jakob L. Poulsen ◽  
Klaus Krogh ◽  
Christina Brock ◽  
Donghua Liao ◽  
...  
Keyword(s):  
Experimental Model ◽  
Anal Sphincter ◽  
Bowel Dysfunction ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
The Impact

scholarly journals O5 Dose mean opening pressure predominantly assess internal anal sphincter function

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
C M Byrne ◽  
A Sharma ◽  
E S Kiff ◽  
K J Telford
Keyword(s):  
Abdominal Surgery ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
External Anal Sphincter ◽  
General Anaesthetic ◽  
Opening Pressure ◽  
Rectal Distension ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
Inhibitory Reflex

Abstract Introduction We have suggested that mean Opening Pressure (Op) recorded during Anal Acoustic Reflectometry (AAR) predominantly represents IAS function however, the extent remains unknown. The aim was to investigate this by excluding the external anal sphincter during general anaesthetic (GA) with confirmed neuromuscular blockade (NMB). Method Patients undergoing elective abdominal surgery requiring GA+NMB were approached. Patients had pre-operative (awake) and during GA + NMB (asleep) AAR measurements performed. The rectoanal inhibitory reflex (RAIR) was assessed permitting the Op value to also be recorded when the IAS was inhibited. Op was recorded at prerectal distension and then after 100 mls of air was inflated within a balloon in the rectum (post-rectal distension). Result 19 patients were included. The values of Op (cmH20) and the reductions observed during the RAIR when awake/asleep are as follows: Awake Op: prerectal distension (64.94) and post-rectal distension (35.35) therefore mean change 29.59 cmH2O i.e. 44.6% reduction Asleep Op: prerectal distension (37.64) and post-rectal distension (15.55) therefore mean change 22.1 i.e. 55.3% reduction The contribution of the IAS to Op is calculated as follows: (Mean change Op awake x 100)/% reduction in RAIR asleep = IAS contribution awake (29.59cmH20 x 100)/55.3 = 53.51cmH20 Total mean Op awake—IAS contribution awake = EAS contribution awake 64.94cmH20–53.51cmH20 (82.4%) = 11.43cmH20 (17.6%) Conclusion The IAS accounts for 82.4% of Op at rest and it remains our hypothesis that Op primarily represents IAS function. Take-home Message Opening pressure primarily represents internal anal sphincter function.

Traditional measures of normal anal sphincter function using high-resolution anorectal manometry (HRAM) in 115 healthy volunteers

2014 ◽  
Vol 26 (5) ◽  
pp. 625-635 ◽  
Author(s):  
E. V. Carrington ◽  
A. Brokjaer ◽  
H. Craven ◽  
N. Zarate ◽  
E. J. Horrocks ◽  
...  
Keyword(s):  
High Resolution ◽  
Healthy Volunteers ◽  
Anal Sphincter ◽  
Anorectal Manometry ◽  
Sphincter Function ◽  
Anal Sphincter Function

The Effects of Age and Childbirth on Anal Sphincter Function and Morphology in 999 Symptomatic Female Patients With Colorectal Dysfunction

2012 ◽  
Vol 55 (3) ◽  
pp. 286-293 ◽  
Author(s):  
D. J. Boyle ◽  
C. H. Knowles ◽  
J. Murphy ◽  
C. Bhan ◽  
N. S. Williams ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
Female Patients

Anal sphincter function and rectal reservoir after sphincter saving operations for carcinoma of the rectum

1983 ◽  
Vol 13 (5) ◽  
pp. 420-425 ◽  
Author(s):  
Naomi Iwai ◽  
Kyozo Hashimoto ◽  
Hirofumi Kaneda ◽  
Osamu Kojima ◽  
Bunzo Nishioka ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Carcinoma Of The Rectum ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
Sphincter Saving

Spontaneous variation of anal "resting" pressure in healthy humans

1991 ◽  
Vol 261 (5) ◽  
pp. G823-G826
Author(s):  
P. Enck ◽  
E. Eggers ◽  
S. Koletzko ◽  
J. F. Erckenbrecht
Keyword(s):  
Anal Sphincter ◽  
Dynamic Structure ◽  
Anal Pressure ◽  
Cyclic Activity ◽  
Healthy Humans ◽  
Resting Pressure ◽  
Defecation Disorders ◽  
Anal Resting Pressure ◽  
Transducer Probe

To investigate anal sphincter performance during sleep and after a meal, a two-channel micro-transducer probe was used for 12-h stationary recording of basal anal pressure overnight in eight healthy male volunteers. It was shown that the basal anal pressure ("resting" pressure) exhibits three distinct patterns of cyclic activity changes in all subjects: a long-term rhythm with a prominent decrease of pressure during which sleep was approximately circadian, an ultradian rhythm of approximately 20 to 40 min in length that was more prominent at night, and spontaneous relaxations of the sphincter tone occurring between 3 and 20 times per hour with the maximum frequency after breakfast. These data indicate that the anal sphincter is a dynamic structure not often at rest. Long-term anorectal manometry may be supplementary to short-term clinical evaluation of anal sphincter performance in healthy subjects as well as in patients with defecation disorders.

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