IV Naloxone Infusion: A Hidden Gem

Despite the current opioid crisis, opioids remain the mainstay of analgesic therapy. They are associated with a multitude of side effects, including respiratory depression, pruritus, nausea, vomiting, urinary retention, ileus, and constipation. Beyond certain doses and duration of intake that vary from patient to patient, opioids can also induce a state of paradoxical hyperalgesia. Among these side effects, opioid induced ileus, urinary retention, and opioid induced hyperalgesia contribute to unnecessary prolongation of hospital length of stay. Naloxone is a well known antagonist used to reverse opioid induced respiratory depression. There is evidence supporting the use of low dose IV naloxone to prevent and reverse all of the above mentioned opioid induced side effects without reversing the analgesia. However, low dose IV naloxone appears to be underutilized. In addition to reviewing the literature, we will share our experience and clinical results from the implementation of low dose IV naloxone protocols at Cedars Sinai Medical Center in Los Angeles. (Recorded at PAINWeek 2018)