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

Management of postoperative ileus: focus on alvimopan

Authors Eric L Marderstein, Conor P Delaney

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


Review by Single-blind

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 This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at 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.

Download Article [PDF] 


Readers of this article also read:

Polycaprolactone scaffold engineered for sustained release of resveratrol: therapeutic enhancement in bone tissue engineering

Kamath MS, Ahmed SS, Dhanasekaran M, Winkins Santosh S

International Journal of Nanomedicine 2014, 9:183-195

Published Date: 23 December 2013

Hypergeometric analysis of tiling-array and sequence data: detection and interpretation of peaks

Taskesen E, Hoogeboezem R, Delwel R, Reinders MJT

Advances and Applications in Bioinformatics and Chemistry 2013, 6:55-62

Published Date: 25 October 2013

Delivering hydrophilic and hydrophobic chemotherapeutics simultaneously by magnetic mesoporous silica nanoparticles to inhibit cancer cells

Liu Q, Zhang J, Sun W, Xie QR, Xia W, Gu H

International Journal of Nanomedicine 2012, 7:999-1013

Published Date: 24 February 2012

Impact of heat treatment on size, structure, and bioactivity of elemental selenium nanoparticles

Zhang J, Taylor EW, Wan X, Peng D

International Journal of Nanomedicine 2012, 7:815-825

Published Date: 17 February 2012

Surface decoration by Spirulina polysaccharide enhances the cellular uptake and anticancer efficacy of selenium nanoparticles

Yang F, Tang Q, Zhong X, Bai Y, Chen T, Zhang Y, Li Y, Zheng W

International Journal of Nanomedicine 2012, 7:835-844

Published Date: 17 February 2012

Ocular hypotensive effect and safety of travoprost 0.004%/timolol maleate 0.5% fixed combination after change of treatment regimen from ß-blockers and prostaglandin analogs

Inoue K, Setogawa A, Higa R, Moriyama R, Wakakura M, Tomita G

Clinical Ophthalmology 2012, 6:231-235

Published Date: 10 February 2012

Development of an MRI-visible nonviral vector for siRNA delivery targeting gastric cancer

Chen Y, Wang W, Lian G, Qian C, Wang L, Zeng L, Liao C, Liang B, Huang B, Huang K, Shuai X

International Journal of Nanomedicine 2012, 7:359-368

Published Date: 31 January 2012

Long-term use and tolerability of irbesartan for control of hypertension

Forni V, Wuerzner G, Pruijm M, Burnier M

Integrated Blood Pressure Control 2011, 4:17-26

Published Date: 18 April 2011

Advances in polyelectrolyte multilayer nanofilms as tunable drug delivery systems

Bingbing Jiang, John B Barnett, Bingyun Li

Nanotechnology, Science and Applications 2009, 2:21-27

Published Date: 5 August 2009