Analyze Diet
Frontiers in pain research (Lausanne, Switzerland)2024; 5; 1347548; doi: 10.3389/fpain.2024.1347548

The impact of opioid administration on the incidence of postanaesthetic colic in horses.

Abstract: Effective management of postoperative pain is essential to ensure patient welfare, reduce morbidity and optimize recovery. Opioids are effective in managing moderate to severe pain in horses but concerns over their adverse effects on gastrointestinal (GI) motility and associated increased colic risk limit their widespread use. Studies investigating the impact of systemic opioids on both GI motility and colic incidence in horses have yielded inconclusive outcomes. Therefore, this retrospective study aims to assess the influence of systemic administration of butorphanol, morphine, and methadone on post-anaesthetic colic (PAC) incidence. Horses undergoing general anaesthesia for non-gastrointestinal procedures that were hospitalized for at least 72 h post-anaesthesia were included in this study. Anaesthetised horses were stratified by procedure type into horses undergoing diagnostic imaging without surgical intervention, emergency or elective surgery. In addition, patients were grouped by opioid treatment regime into horses receiving no opioids, intraanaesthetic, short- (<24 h) or long-term (>24 h) postoperative opioids. Administered opioids encompassed butorphanol, morphine and methadone. The number of horses showing signs of colic in the 72 h after anaesthesia was assessed for each group. A total of 782 horses were included, comprising 659 undergoing surgical procedures and 123 undergoing diagnostic imaging. The overall PAC incidence was 15.1%. Notably, horses undergoing diagnostic imaging without surgery had a significantly lower PAC rate of 6.5% compared to those undergoing surgery (16.7%,  = 0.0146). Emergency surgeries had a significantly lower PAC rate of 5.8% compared to elective procedures (18%,  = 0.0113). Of the 782 horses, 740 received intraoperative opioids and 204 postoperative opioids, 102 of which long-term (≥24 h). Neither intraoperative ( = 0.4243) nor short-term postoperative opioids ( = 0.5744) increased PAC rates. Notably, only the long-term (≥24 h) administration of morphine significantly increased PAC incidence to 34% ( = 0.0038). In contrast, long-term butorphanol (5.3% PAC,  = 0.8482) and methadone (18.4% PAC,  = 0.6161) did not affect PAC rates. In summary, extended morphine administration was the only opioid treatment associated with a significantly increased risk of PAC.
Publication Date: 2024-02-19 PubMed ID: 38440199PubMed Central: PMC10910105DOI: 10.3389/fpain.2024.1347548Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research looks into the effect of pain relief drugs butorphanol, morphine, and methadone on the occurrence of colic after anesthesia among horses. The findings indicate that only long-term use of morphine was observed to significantly increase the incidence of post-anaesthetic colic.

Study Design and Sample

  • This was a retrospective study involving 782 horses. The subjects were made up of those that underwent general anaesthesia for non-gastrointestinal procedures and stayed in hospital for at least 72 hours after anaesthesia.
  • The group was further divided based on the type of procedure into horses undergoing diagnostic imaging without surgical intervention, and those undergoing either emergency or elective surgery.
  • Another classification was based on the opioid treatment regime. These included horses not receiving any opioids, and those receiving intraanaesthetic, short-term (less than 24 hours), or long-term (more than 24 hours) postoperative opioids.

Main Findings

  • The overall incidence of post-anaesthetic colic (PAC) was 15.1%. A significant finding was that horses undergoing diagnostic imaging without surgery registered a significantly lower PAC rate of 6.5% compared to those undergoing surgery (16.7%).
  • Emergency surgeries also recorded a significantly lower PAC rate of 5.8% compared to elective procedures (18%).
  • Of the 782 horses, 740 received intraoperative opioids and 204 postoperative opioids, with 102 of these receiving long-term (more than 24 hours) treatment.
  • However, neither intraoperative nor short-term postoperative opioids were seen to increase PAC rates.
  • Notably, only long-term administration of morphine significantly increased the PAC incidence to 34%. In contrast, long-term butorphanol and methadone did not affect PAC rates.

Conclusions

  • The study concluded that extended morphine administration was the only opioid treatment associated with a significantly increased risk of post-anaesthetic colic in horses.
  • This is an important consideration for veterinarians when choosing pain management strategies for horses, taking into account the potential higher risk of colic from long-term morphine use.

Cite This Article

APA
Haralambus R, Juri M, Mokry A, Jenner F. (2024). The impact of opioid administration on the incidence of postanaesthetic colic in horses. Front Pain Res (Lausanne), 5, 1347548. https://doi.org/10.3389/fpain.2024.1347548

Publication

ISSN: 2673-561X
NlmUniqueID: 9918227269806676
Country: Switzerland
Language: English
Volume: 5
Pages: 1347548
PII: 1347548

Researcher Affiliations

Haralambus, Rhea
  • Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
Juri, Michaela
  • Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
Mokry, Anna
  • Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
Jenner, Florien
  • Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

This article includes 70 references
  1. Clark L, Clutton RE, Blissitt KJ, Chase-Topping ME. Effects of peri-operative morphine administration during halothane anaesthesia in horses.. Vet Anaesth Analg (2005) 32:10–5.
  2. Carregaro AB, Freitas GC, Ribeiro MH, Xavier NV, Dória RG. Physiological and analgesic effects of continuous-rate infusion of morphine, butorphanol, tramadol or methadone in horses with lipopolysaccharide (LPS)-induced carpal synovitis.. BMC Vet Res (2014) 10:966.
    doi: 10.1186/s12917-014-0299-zpmc: PMC4297404pubmed: 25528353google scholar: lookup
  3. Love EJ, Lane JG, Murison PJ. Morphine administration in horses anaesthetized for upper respiratory tract surgery.. Vet Anaesth Analg (2006) 33:179–88.
  4. Love EJ, Taylor PM, Whay HR, Murrell J. Postcastration analgesia in ponies using buprenorphine hydrochloride.. Vet Rec (2013) 172:635–635.
    doi: 10.1136/vr.101440pubmed: 23736517google scholar: lookup
  5. Senior JM, Pinchbeck GL, Dugdale AHA, Clegg PD. Retrospective study of the risk factors and prevalence of colic in horses after orthopaedic surgery.. Vet Rec (2004) 155:321–5.
    doi: 10.1136/vr.155.11.321pubmed: 15470967google scholar: lookup
  6. Andersen MS, Clark L, Dyson SJ, Newton JR. Risk factors for colic in horses after general anaesthesia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine.. Equine Vet J (2006) 38:368–74.
    doi: 10.2746/042516406777749263pubmed: 16866208google scholar: lookup
  7. Tessier C, Pitaud J-P, Thorin C, Touzot-Jourde G. Systemic morphine administration causes gastric distention and hyperphagia in healthy horses.. Equine Vet J (2019) 51:653–7.
    doi: 10.1111/evj.13090pubmed: 30835841google scholar: lookup
  8. Levionnois OL, Graubner C, Spadavecchia C. Colon constipation in horses after sustained-release buprenorphine administration.. Vet Anaesth Analg (2018) 45:876–80.
    doi: 10.1016/j.vaa.2018.08.004pubmed: 30297131google scholar: lookup
  9. Boscan P, Hoogmoed LMV, Farver TB, Snyder JR. Evaluation of the effects of the opioid agonist morphine on gastrointestinal tract function in horses.. Am J Vet Res (2006) 67:992–7.
    doi: 10.2460/ajvr.67.6.992pubmed: 16740092google scholar: lookup
  10. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N. Opioid complications and side effects.. Pain Physician (2008) 11:S105–20.
    doi: 10.36076/ppj.2008/11/S105pubmed: 18443635google scholar: lookup
  11. Chamie K, Golla V, Lenis AT, Lec PM, Rahman S, Viscusi ER. Peripherally acting μ-opioid receptor antagonists in the management of postoperative ileus: a clinical review.. J Gastrointest Surg (2021) 25:293–302.
    doi: 10.1007/s11605-020-04671-xpmc: PMC7851096pubmed: 32779081google scholar: lookup
  12. Corsetti M, Pannemans J, Whorwell P. Targeting mu opioid receptors to modulate gastrointestinal function: what have we learnt so far from the studies in functional bowel disorders?. F1000Res (2019) 8:F1000 Faculty Rev-257.
  13. Galligan JJ, Sternini C. Insights into the role of opioid receptors in the GI tract: experimental evidence and therapeutic relevance.. Handb Exp Pharmacol (2017) 239:363–78.
    doi: 10.1007/164_2016_116pmc: PMC6310692pubmed: 28204957google scholar: lookup
  14. Mosiska P, Zieliska M, Fichna J. Expression and physiology of opioid receptors in the gastrointestinal tract.. Curr Opin Endocrinol Diabetes Obes (2016) 23:3–10.
    doi: 10.1097/med.0000000000000219pubmed: 26702845google scholar: lookup
  15. Sobczak M, Sałaga M, Storr MA, Fichna J. Physiology, signaling, and pharmacology of opioid receptors and their ligands in the gastrointestinal tract: current concepts and future perspectives.. J Gastroenterol (2014) 49:24–45.
    doi: 10.1007/s00535-013-0753-xpmc: PMC3895212pubmed: 23397116google scholar: lookup
  16. Wade PR, Palmer JM, McKenney S, Kenigs V, Chevalier K, Moore BA. Modulation of gastrointestinal function by MuDelta, a mixed µ opioid receptor agonist/µ opioid receptor antagonist.. Br J Pharmacol (2012) 167:1111–25.
  17. Holzer P. Opioid receptors in the gastrointestinal tract.. Regul Pept (2009) 155:11–7.
  18. Yuan C-S. Clinical status of methylnaltrexone, a new agent to prevent and manage opioid-induced side effects.. J Support Oncol (2004) 2:111–7; discussion 119–22.
    pubmed: 15328815
  19. Mercadante S, Casuccio A, Fulfaro F, Groff L, Boffi R, Villari P. Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study.. J Clin Oncol (2001) 19:2898–904.
    doi: 10.1200/jco.2001.19.11.2898pubmed: 11387363google scholar: lookup
  20. Roger T, Bardon T, Ruckebusch Y. Colonic motor responses in the pony: relevance of colonic stimulation by opiate antagonists.. Am J Vet Res (1985) 46:31–5.
    pubmed: 3970439
  21. Poole DP, Pelayo J-C, Scherrer G, Evans CJ, Kieffer BL, Bunnett NW. Localization and regulation of fluorescently labeled delta opioid receptor, expressed in enteric neurons of mice.. Gastroenterology (2011) 141:982–91.e18.
  22. Sternini C, Patierno S, Selmer I-S, Kirchgessner A. The opioid system in the gastrointestinal tract.. Neurogastroenterol Motil (2004) 16:3–16.
  23. Luca AD, Coupar IM. Insights into opioid action in the intestinal tract.. Pharmacol Ther (1996) 69:103–15.
    doi: 10.1016/0163-7258(95)02053-5pubmed: 8984506google scholar: lookup
  24. Nannarone S, Giannettoni G, Laurenza C, Giontella A, Moretti G. Methadone or butorphanol as pre-anaesthetic agents combined with romifidine in horses undergoing elective surgery: qualitative assessment of sedation and induction.. Animals (Basel) (2021) 11:2572.
    doi: 10.3390/ani11092572pmc: PMC8467133pubmed: 34573538google scholar: lookup
  25. Jago RC, Corletto F, Wright IM. Peri-anaesthetic complications in an equine referral hospital: risk factors for post anaesthetic colic.. Equine Vet J (2015) 47:635–40.
    doi: 10.1111/evj.12475pubmed: 26095513google scholar: lookup
  26. Senior JM, Pinchbeck GL, Allister R, Dugdale AHA, Clark L, Clutton RE. Post anaesthetic colic in horses: a preventable complication?. Equine Vet J (2006) 38:479–84.
    doi: 10.2746/042516406778400673pubmed: 16986610google scholar: lookup
  27. Nelson BB, Lordan EE, Hassel DM. Risk factors for gastrointestinal dysfunction following elective anaesthesia.. Equine Vet J (2013) 45:8–14.
    doi: 10.1111/evj.12162pubmed: 24304397google scholar: lookup
  28. Patipa LA, Sherlock CE, Witte SH, Pirie GD, Berghaus RD, Peroni JF. Risk factors for colic in equids hospitalized for ocular disease.. J Am Vet Méd Assoc (2012) 240:1488–93.
    doi: 10.2460/javma.240.12.1488pubmed: 22657933google scholar: lookup
  29. Skrzypczak H, Reed R, Barletta M, Quandt J, Sakai D. A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses.. Vet Anaesth Analg (2020) 47:757–62.
    doi: 10.1016/j.vaa.2020.06.003pubmed: 32830037google scholar: lookup
  30. Felden L, Walter C, Harder S, Treede R-D, Kayser H, Drover D. Comparative clinical effects of hydromorphone and morphine: a meta-analysis.. Br J Anaesth (2011) 107:319–28.
    doi: 10.1093/bja/aer232pubmed: 21841049google scholar: lookup
  31. Mancini IL, Hanson J, Neumann CM, Bruera ED. Opioid type and other clinical predictors of laxative dose in advanced cancer patients: a retrospective study.. J Palliat Med (2000) 3:49–56.
    doi: 10.1089/jpm.2000.3.49pubmed: 15859721google scholar: lookup
  32. Reed R, Trenholme N, Skrzypczak H, Chang K, Ishikawa Y, Barletta M. Comparison of hydromorphone and butorphanol for management of pain in equine patients undergoing elective arthroscopy: a randomized clinical trial.. Vet Anaesth Analg (2022) 49:490–8.
    doi: 10.1016/j.vaa.2022.05.006pubmed: 35752564google scholar: lookup
  33. Emanuel D, Kästner SBR, Delarocque J, Grob AJ, Bienert-Zeit A. Influence of butorphanol, buprenorphine and levomethadone on sedation quality and postoperative analgesia in horses undergoing cheek tooth extraction.. Vet Sci (2022) 9:174.
    doi: 10.3390/vetsci9040174pmc: PMC9029614pubmed: 35448672google scholar: lookup
  34. Dias BP, de Araújo MA, Deschk M, Trein TA, Pinheiro NC, Perri SHV. Effects of a continuous rate infusion of butorphanol in isoflurane-anesthetized horses on cardiorespiratory parameters, recovery quality, gastrointestinal motility and serum cortisol concentrations.. Acta Cir Bras (2014) 29:801–6.
  35. Sojka JE, Adams SB, Lamar CH, Eller LL. Effect of butorphanol, pentazocine, meperidine, or metoclopramide on intestinal motility in female ponies.. Am J Vet Res (1988) 49:527–9.
    pubmed: 3377314
  36. Natalini CC, Robinson EP. Evaluation of the analgesic effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H in horses.. Am J Vet Res (2000) 61:1579–86.
    doi: 10.2460/ajvr.2000.61.1579pubmed: 11131602google scholar: lookup
  37. Sellon DC, Roberts MC, Blikslager AT, Ulibarri C, Papich MG. Effects of continuous rate intravenous infusion of butorphanol on physiologic and outcome variables in horses after celiotomy.. J Vet Intern Med (2004) 18:555.
  38. Commiskey S, Fan L-W, Ho IK, Rockhold RW. Butorphanol: effects of a prototypical agonist-antagonist analgesic on κ-opioid receptors.. J Pharmacol Sci (2005) 98:109–16.
    doi: 10.1254/jphs.crj05001xpubmed: 15942128google scholar: lookup
  39. Bacon EK, Donnelly CG, Bellone RR, Finno CJ, Velie BD. Melanocortin-1 receptor influence in equine opioid sensitivity.. Equine Vet Educ (2023) 35:152–62.
    doi: 10.1111/eve.13661google scholar: lookup
  40. Figueiredo JP, Muir WW, Sams R. Cardiorespiratory, gastrointestinal, and analgesic effects of morphine sulfate in conscious healthy horses.. Am J Vet Res (2012) 73:799–808.
    doi: 10.2460/ajvr.73.6.799pubmed: 22620693google scholar: lookup
  41. Mircica E, Clutton RE, Kyles KW, Blissitt KJ. Problems associated with perioperative morphine in horses: a retrospective case analysis.. Vet Anaesth Analg (2003) 30:147–55.
  42. Martin-Flores M, Campoy L, Kinsley MA, Mohammed HO, Gleed RD, Cheetham J. Analgesic and gastrointestinal effects of epidural morphine in horses after laparoscopic cryptorchidectomy under general anesthesia.. Vet Anaesth Analg (2014) 41:430–7.
    doi: 10.1111/vaa.12133pubmed: 24576158google scholar: lookup
  43. Imam MZ, Kuo A, Ghassabian S, Smith MT. Progress in understanding mechanisms of opioid-induced gastrointestinal adverse effects and respiratory depression.. Neuropharmacology (2018) 131:238–55.
  44. Wolff RF, Aune D, Truyers C, Hernandez AV, Misso K, Riemsma R. Systematic review of efficacy and safety of buprenorphine versus fentanyl or morphine in patients with chronic moderate to severe pain.. Curr Méd Res Opin (2012) 28:833–45.
    doi: 10.1185/03007995.2012.678938pubmed: 22443154google scholar: lookup
  45. Kuo A, Wyse BD, Meutermans W, Smith MT. In vivo profiling of seven common opioids for antinociception, constipation and respiratory depression: no two opioids have the same profile.. Br J Pharmacol (2013) 172:532–48.
    doi: 10.1111/bph.12696pmc: PMC4292966pubmed: 24641546google scholar: lookup
  46. Mori T, Shibasaki Y, Matsumoto K, Shibasaki M, Hasegawa M, Wang E. Mechanisms that underlie μ-opioid receptor agonist–induced constipation: differential involvement of μ-opioid receptor sites and responsible regions.. J Pharmacol Exp Ther (2013) 347:91–9.
    doi: 10.1124/jpet.113.204313pubmed: 23902939google scholar: lookup
  47. Matsumoto K, Umemoto H, Mori T, Akatsu R, Saito S, Tashima K. Differences in the morphine-induced inhibition of small and large intestinal transit: involvement of central and peripheral μ-opioid receptors in mice.. Eur J Pharmacol (2016) 771:220–8.
    doi: 10.1016/j.ejphar.2015.12.033pubmed: 26712376google scholar: lookup
  48. Combie JD, Nugent TE, Tobin T. Pharmacokinetics and protein binding of morphine in horses.. Am J Vet Res (1983) 44:870–4.
    pubmed: 6869996
  49. Hamamoto-Hardman BD, Steffey EP, Weiner D, McKemie DS, Kass P, Knych HK. Pharmacokinetics and selected pharmacodynamics of morphine and its active metabolites in horses after intravenous administration of four doses.. J Vet Pharmacol Ther (2019) 42:401–10.
    doi: 10.1111/jvp.12759pubmed: 30919469google scholar: lookup
  50. Knych HK, Steffey EP, McKemie DS. Preliminary pharmacokinetics of morphine and its major metabolites following intravenous administration of four doses to horses.. J Vet Pharmacol Ther (2014) 37:374–81.
    doi: 10.1111/jvp.12098pubmed: 24479785google scholar: lookup
  51. Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits.. Clin Gastroenterol Hepatol (2017) 15:1338–49.
    doi: 10.1016/j.cgh.2017.05.014pmc: PMC5565678pubmed: 28529168google scholar: lookup
  52. Wood JD, Galligan JJ. Function of opioids in the enteric nervous system.. Neurogastroenterol Motil (2004) 16:17–28.
  53. Lay J, Carbone SE, DiCello JJ, Bunnett NW, Canals M, Poole DP. Distribution and trafficking of the μ-opioid receptor in enteric neurons of the Guinea pig.. Am J Physiol-Gastrointest Liver Physiol (2016) 311:G252–66.
    doi: 10.1152/ajpgi.00184.2016pubmed: 27365337google scholar: lookup
  54. Schepper HUD, Cremonini F, Park M-I, Camilleri M. Opioids and the gut: pharmacology and current clinical experience.. Neurogastroenterol Motil (2004) 16:383–94.
  55. Beckett EAH, Staikopoulos V, Hutchinson MR. Differential effect of morphine on gastrointestinal transit, colonic contractions and nerve-evoked relaxations in toll-like receptor deficient mice.. Sci Rep (2018) 8:5923.
    doi: 10.1038/s41598-018-23717-4pmc: PMC5897409pubmed: 29651005google scholar: lookup
  56. Shook JE, Pelton JT, Lemcke PK, Porreca F, Hruby VJ, Burks TF. Mu opioid antagonist properties of a cyclic somatostatin octapeptide in vivo: identification of mu receptor-related functions.. J Pharmacol Exp Ther (1987) 242:1–7.
    pubmed: 2886635
  57. Roy S, Liu H-C, Loh HH. μ-Opioid receptor-knockout mice: the role of μ-opioid receptor in gastrointestinal transit.. Mol Brain Res (1998) 56:281–3.
    doi: 10.1016/s0169-328x(98)00051-5pubmed: 9602153google scholar: lookup
  58. Holzer P. Opioids and opioid receptors in the enteric nervous system: from a problem in opioid analgesia to a possible new prokinetic therapy in humans.. Neurosci Lett (2004) 361:192–5.
    doi: 10.1016/j.neulet.2003.12.004pubmed: 15135926google scholar: lookup
  59. Horan PJ, Ho IK. Comparative pharmacological and biochemical studies between butorphanol and morphine.. Pharmacol Biochem Behav (1989) 34:847–54.
    doi: 10.1016/0091-3057(89)90284-0pubmed: 2623037google scholar: lookup
  60. Daeninck PJ, Bruera E. Reduction in constipation and laxative requirements following opioid rotation to methadone.. J Pain Symptom Manag (1999) 18:303–9.
    doi: 10.1016/s0885-3924(99)00086-xpubmed: 10534971google scholar: lookup
  61. Leppert W. The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities.. Contemp Oncol (2012) 16:125–31.
    doi: 10.5114/wo.2012.28792pmc: PMC3687404pubmed: 23788866google scholar: lookup
  62. Foong A-L, Grindrod KA, Patel T, Kellar J. Demystifying serotonin syndrome (or serotonin toxicity).. Can Fam Physician Med Fam Can (2018) 64:720–7.
    pmc: PMC6184959pubmed: 30315014
  63. Tonini M, Pace F. Drugs acting on serotonin receptors for the treatment of functional GI disorders.. Dig Dis (2006) 24:59–69.
    doi: 10.1159/000090309pubmed: 16699264google scholar: lookup
  64. Gershon MD. Review article: serotonin receptors and transporters—roles in normal and abnormal gastrointestinal motility.. Aliment Pharmacol Ther (2004) 20:3–14.
  65. Costedio MM, Hyman N, Mawe GM. Serotonin and its role in colonic function and in gastrointestinal disorders.. Dis Colon Rectum (2007) 50:376–88.
    doi: 10.1007/s10350-006-0763-3pubmed: 17195902google scholar: lookup
  66. Kuo CP, Jao SW, Chen KM, Wong CS, Yeh CC, Sheen MJ. Comparison of the effects of thoracic epidural analgesia and i.v. Infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery.. Br J Anaesth (2006) 97:640–6.
    doi: 10.1093/bja/ael217pubmed: 16952918google scholar: lookup
  67. Hasuo H, Kusunoki H, Kanbara K, Abe T, Yunoki N, Haruma K. Tolerable pain reduces gastric fundal accommodation and gastric motility in healthy subjects: a crossover ultrasonographic study.. Biopsychosoc Med (2017) 11:4.
    doi: 10.1186/s13030-017-0089-5pmc: PMC5286732pubmed: 28163776google scholar: lookup
  68. Luckey A, Livingston E, Taché Y. Mechanisms and treatment of postoperative ileus.. Arch Surg (2003) 138:206–14.
    doi: 10.1001/archsurg.138.2.206pubmed: 12578422google scholar: lookup
  69. Carroll J, Alavi K. Pathogenesis and management of postoperative ileus.. Clin Colon Rectal Surg (2009) 22:047–50.
    doi: 10.1055/s-0029-1202886pmc: PMC2780226pubmed: 20119556google scholar: lookup
  70. Menozzi A, Pozzoli C, Zullian C, Poli E, Serventi P, Bertini S. Inhibition of motility in isolated horse small intestine is mediated by κ but not µ opioid receptors.. Equine Vet J (2012) 44:368–70.

Citations

This article has been cited 0 times.