Back to Journals » Therapeutics and Clinical Risk Management » Volume 4 » Issue 5

Management of postoperative ileus: focus on alvimopan

Authors Marderstein EL, Delaney CP

Published 10 October 2008 Volume 2008:4(5) Pages 965—973

DOI https://doi.org/10.2147/TCRM.S3147

Review by Single anonymous peer review

Peer reviewer comments 5



Eric L Marderstein, Conor P Delaney

Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western, Reserve School of Medicine, Cleveland, Ohio, USA

Abstract: Postoperative ileus (POI) is a transient loss of coordinated peristalsis precipitated by surgery and exacerbated by opioid pain medication. Ileus causes a variety of symptoms including bloating, pain, nausea, and vomiting, but particularly delays tolerance of oral diet and liquids. Thus POI is a primary determinant of hospital stay after surgery. ‘Fast-track’ recovery protocols, opioid sparing analgesia, and laparoscopic surgery reduce but do not eliminate postoperative ileus. Alvimopan is a mu opioid receptor antagonist that blocks the effects of opioids on the intestine, while not interfering with their centrally mediated analgesic effect. Several large randomized clinical trials have demonstrated that alvimopan accelerates the return of gastrointestinal function after surgery and subsequent hospital discharge by approximately 20 hours after elective open segmental colectomy. However, it has not been tested in patients undergoing laparoscopic surgery and is less effective in patients receiving nonsteroidal antiinflammatory agents in a narcotic sparing postoperative pain control regimen. Safety concerns seen with chronic low dose administration of alvimopan for opioid bowel dysfunction have not been noted with its acute use for POI.

Keywords: alvimopan, postoperative ileus, gastrointestinal surgery

Creative Commons License © 2008 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.