Constipation Medication Before Hip Surgery
Yes, you can take constipation medication before hip surgery, but you should hold it on the day of operation. 1
Recommendations for Specific Constipation Medications
Peripherally Acting Mu Opioid Receptor Antagonists
- Alvimopan: Take preoperatively, but hold on day of operation 1
- Methylnaltrexone: Take preoperatively, but hold on day of operation 1
- Naldemedine: Take preoperatively, but hold on day of operation 1
- Naloxegol: Take preoperatively if given orally, but hold on day of operation 1
Rationale and Benefits
- Constipation is a common problem following hip surgery, with up to 69.1% of patients developing constipation during the first postoperative days 2
- Proactive management of constipation can reduce postoperative complications and improve outcomes 3
- Studies have shown that patients who received combination treatments for constipation prevention had significantly lower rates of postoperative constipation (25% versus 55%) compared to those who received only preoperative education 4
Perioperative Considerations
- Constipation medications, particularly opioid antagonists, may interact with anesthetic agents and pain medications used during surgery 1
- Holding these medications on the day of surgery helps prevent potential drug interactions while maintaining their beneficial effects from previous days 1
- Patients with hip fractures are at increased risk for gastrointestinal complications, making proper bowel management important 5
Postoperative Management
- Normal defecation patterns may take up to 9.5 days to re-establish after hip surgery, with some patients (22.7%) not returning to normal patterns within 30 days 2
- Implementation of a comprehensive bowel protocol has been shown to decrease constipation rates from 120 per 1,000 cases to 37 per 1,000 cases in hip arthroplasty patients 6
Precautions
- Monitor for potential drug interactions between constipation medications and other perioperative medications 1
- Be aware that peripherally acting mu opioid receptor antagonists may cause symptoms of opioid withdrawal if combined with other antagonists 1
- Ensure adequate hydration before induction of and during anesthesia, as this is important for overall perioperative management 1
Additional Considerations
- For optimal pain management after surgery, a multimodal approach including paracetamol and NSAIDs/COX-2 inhibitors is recommended 1
- Dexamethasone (8-10 mg IV) is recommended for perioperative pain management and may also help reduce nausea and vomiting 1
Remember to inform your anesthesiologist and surgeon about all medications you are taking, including constipation medications, during your preoperative assessment 1.