From the Guidelines
Non-opioid pain medications such as anticholinergics, antispasmodics, and somatostatin analogs can be used for managing small bowel obstruction, with the goal of reducing symptoms and improving quality of life. The management of small bowel obstruction often involves a multimodal approach, including pharmacologic and non-pharmacologic interventions. According to the most recent and highest quality study 1, anticholinergic agents can be used to manage colicky pain, while prokinetic treatments may help improve dysmotility and reduce symptoms such as vomiting and constipation.
- Key non-opioid options for small bowel obstruction pain management include:
- Anticholinergics, such as scopolamine or hyoscyamine, which can help reduce cramping pain
- Antispasmodics, such as hyoscine butylbromide (Buscopan), which can help relieve cramping pain
- Somatostatin analogs, such as octreotide, which can help reduce symptoms such as vomiting and pain
- The use of these medications should be tailored to the individual patient, considering the severity of obstruction, underlying cause, and whether surgical intervention is planned, as recommended by 1.
- It is also important to note that the management of small bowel obstruction should prioritize reducing symptoms and improving quality of life, rather than solely focusing on pain management, as highlighted in 1.
From the FDA Drug Label
ACTIVE INGREDIENT (IN EACH CAPLET) Acetaminophen USP, 650 mg The total combined duration of use of ketorolac tromethamine tablets and IV or IM dosing of ketorolac tromethamine is not to exceed 5 days in adults. Those who responded to treatment were then randomized in the double-blind treatment phase to either the dose achieved in the open-label phase or to placebo.
Non-opioid pain medications available for managing small bowel obstruction include:
- Acetaminophen 2
- Ketorolac 3, however, its use is cautioned due to the risk of gastrointestinal complications, and it is not recommended for more than 5 days
- Pregabalin 4, which is used for managing neuropathic pain associated with spinal cord injury, but its use for small bowel obstruction is not directly mentioned in the label.
From the Research
Non-Opioid Pain Medications for Small Bowel Obstruction
- The studies 5, 6, 7, 8, 9 do not specifically mention non-opioid pain medications for managing small bowel obstruction.
- However, they discuss the management of small bowel obstruction, including correction of physiologic and electrolyte disturbances, bowel rest, and removing the source of the obstruction 6.
- The use of analgesia is mentioned as part of the management of small bowel obstruction 5, but the type of analgesia is not specified.
- It can be inferred that non-opioid pain medications may be used as part of the analgesia regimen, but further research is needed to determine the specific non-opioid pain medications that are effective for managing small bowel obstruction.
Management of Small Bowel Obstruction
- The management of small bowel obstruction includes intravenous fluid resuscitation, analgesia, and determining the need for operative vs. nonoperative therapy 5.
- Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction 5.
- Surgery is needed for strangulation and those that fail nonoperative therapy 5.
- Computed tomography and ultrasound are reliable diagnostic methods for small bowel obstruction 5, 8.