Background: Alvimopan is indicated to accelerate the time to gastrointestinal recovery following partial bowel resection with primary anastomosis. The approved dosing regimen includes an initial dose prior to surgery and 12 mg twice daily after surgery for up to 7 days; however, there are no human studies evaluating the need for the preoperative dose. We report our experience with gastrointestinal recovery when the preoperative dose is omitted. Objective: To evaluate the efficacy of alvimopan therapy when the preoperative dose is not administered. Methods: This retrospective study included elective surgery patients who underwent bowel resection with primary anastomosis without colostomy or ileostomy. The study compared (a) patients who received alvimopan and received a dose preoperatively, (b) patients who received alvimopan but did not receive a dose preoperatively, and (c) matched control patients who did not receive alvimopan. Length of stay following bowel resection, direct hospital costs, time to first bowel movement, and time to oral diet were evaluated. Results: Of 50 patients who received alvimopan, 27 received the preoperative dose and 23 did not. These 50 patients were matched to similar control patients who received no alvimopan during their admission for resection. Compared with controls, time to discharge was significantly shorter in patients who received alvimopan, regardless of whether the preoperative dose was administered (P < .001) or omitted (P = .03). Patients who did not receive the preoperative dose still experienced faster time to first bowel movement (71 vs 97 hours; P = .006) and faster time to first diet (17 vs 54 hours; P < .001) than non–alvimopan users. Conclusion: Patients receiving the approved alvimopan dosing regimen experienced the most rapid recovery of gastrointestinal function. However, administering alvimopan only postoperatively (if the preoperative dose is omitted) may still reduce the severity of postoperative ileus.
HolteKKehletH. Postoperative ileus: a preventable event. Br J Surg. 2000;87:1480-1493.
2.
BauerAJBoeckxstaensGE. Mechanisms of postoperative ileus. Neurogastroenterol Motil. 2004;16:54-60.
3.
WolffBGMichelassiFGerkinTM; Alvimopan Postoperative Ileus Study Group. Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg. 2004;240:728-734.
4.
StorySKChamberlainRS. A comprehensive review of evidence-based strategies to prevent and treat postoperative ileus. Dig Surg. 2009;26:265-275.
5.
PersonBWexnerSD. The management of postoperative ileus. Curr Probl Surg. 2006;43:6-65.
6.
SenagoreAJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm. 2007;64(20 suppl 13):S3-S7.
7.
LuckeyALivingstonETacheY. Mechanisms and treatment of postoperative ileus. Arch Surg. 2003;138:206-214.
8.
KehletHHolteK. Review of postoperative ileus. Am J Surg. 2001;182(suppl 5A):3S-10S.
9.
KraftMMaclarenRDuWOwensG. Alvimopan (entereg) for the management of postoperative ileus in patients undergoing bowel resection. P T. 2010;35:44-49.
10.
SchmidtWK. Alvimopan* (ADL 8-2698) is a novel peripheral opioid antagonist. Am J Surg. 2001;182:27-38.
11.
DelaneyCPWeeseJLHymanNH; Alvimopan Postoperative Ileus Study Group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum. 2005;48:1114-1125.
12.
BüchlerMWSeilerCMMonsonJR. Clinical trial: alvimopan for the management of post-operative ileus after abdominal surgery: results of an international randomized, double-blind, multicentre, placebo-controlled clinical study. Aliment Pharmacol Ther. 2008;28:312-325.
13.
ViscusiERGoldsteinSWitkowskiT. Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc. 2006;20:64-70.
14.
LudwigKEnkerWEDelaneyCP. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg. 2008;143:1098-1105.
15.
AbsherRKGerkinTMBanaresLW. Alvimopan use in laparoscopic and open bowel resections: clinical results in a large community hospital system. Ann Pharmacother. 2010;44:1701-1708.
