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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

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