Alvimopan for postoperative ileus

Bream-Rouwenhorst, Heather R.; Cantrell, Matthew

doi:10.2146/ajhp080445

Cited by 36 publications

(25 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Opioids are associated with POI 1,3,4,10,14 and the dose of morphine required for effective analgesia is in excess of that which causes POI 1,15 . Activation of receptors in the GI tract is responsible for inhibition of gut motility whereas the receptors in the central nervous system mediate analgesia 3,16 . Return of GI function appears to be related to opioid dosage, duration, and route of administration and extent of small intestine, stomach and colon involvement 4,6,10,14 .…”

Section: Introductionmentioning

confidence: 99%

Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries

Gan

Robinson²,

Oderda

et al. 2015

Current Medical Research and Opinion

View full text Add to dashboard Cite

Objectives:To assess the incidence and economic impact of postoperative ileus (POI) following laparotomy (open) and laparoscopic procedures for colectomies and cholecystectomies in patients receiving postoperative pain management with opioids. Methods:Using the Premier research database, we retrospectively identified adult inpatients discharged between 2008 and 2010 receiving postsurgical opioids following laparotomy and laparoscopic colectomy and cholecystectomy. POI was identified through ICD-9 diagnosis codes and postsurgical morphine equivalent dose (MED) determined. Results:A total of 138,068 patients met criteria, and 10.3% had an ileus. Ileus occurred more frequently in colectomy than cholecystectomy and more often when performed by laparotomy. Ileus patients receiving opioids had an increased length of stay (LOS) ranging from 4.8 to 5.7 days, total cost from $9945 to $13,055 and 30 day all-cause readmission rate of 2.3 to 5.3% higher compared to patients without ileus. Patients with ileus received significantly greater MED than those without (median: 285 vs. 95 mg, p50.0001) and were twice as likely to have POI. MED above the median in ileus patients was associated with an increase in LOS (3.8 to 7.1 days), total cost ($8458 to $19,562), and readmission in laparoscopic surgeries (4.8 to 5.2%). Readmission rates were similar in ileus patients undergoing open procedures regardless of MED. Conclusions:Use of opioids in patients who develop ileus following abdominal surgeries is associated with prolonged hospitalization, greater costs, and increased readmissions. Furthermore, higher doses of opioids are associated with higher incidence of POI. Limitations are related to the retrospective design and the use of administrative data (including reliance on ICD-9 coding). Yet POI may not be coded and therefore underestimated in our study. Assessment of pre-existing disease and preoperative pain management was not assessed. Despite these limitations, strategies to reduce opioid consumption may improve healthcare outcomes and reduce the associated economic impact.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries

Gan

Robinson²,

Oderda

et al. 2015

Current Medical Research and Opinion

View full text Add to dashboard Cite

show abstract

“…1,2 Disorders managed by these drugs occur via similar pathophysiology involving endogenous and exogenous stimulation of gastrointestinal m-opioid receptors. 3,4 Postoperative ileus may be caused by various factors, including release of inflammatory mediators and endogenous opioids, as well as postoperative use of opioid medications. 3 Similarly, OIC is caused by stimulation of gastrointestinal m-opioid receptors in patients receiving opioid medications.…”

mentioning

confidence: 99%

“…3,4 Postoperative ileus may be caused by various factors, including release of inflammatory mediators and endogenous opioids, as well as postoperative use of opioid medications. 3 Similarly, OIC is caused by stimulation of gastrointestinal m-opioid receptors in patients receiving opioid medications. 4 The resultant uncoordinated gut motility in both conditions may cause nausea, constipation, vomiting, and, in severe cases, anorexia or aspiration.…”

mentioning

confidence: 99%

Off-label uses of alvimopan and methylnaltrexone

Rodriguez

2014

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

Trials of alvimopan in the FDA-approved use of methylnaltrexone (OIC) indicate potentially serious cardiovascular safety concerns and conflicting findings of efficacy. Similarly, trials of methylnaltrexone in the FDA-approved use of alvimopan (postoperative ileus) consistently showed no benefit. Evaluations of both drugs in their labeled conditions in populations not endorsed in their product labeling have been limited and largely unreplicated.

show abstract

“…7 The degree of surgical manipulation is proportional to the time of the recovery, and it is hypothesized that the small intestine recovers first (within 24 to 48 hours) and the colon last (3 to 5 days), thus making POI the rate-limiting step in recovery. 8,9 Opioid analgesics are considered the standard of care for postoperative pain control in bowel resection patients, but opioids can contribute to the development of POI. 8 By binding to the mu-opioid receptor in the GI tract, opioids can slow gastrointestinal transit, inhibit intestinal ion and fluid secretion, cause nonpropulsive segmental contractions of the small and large intestine, and impair the ability to defecate.…”

mentioning

confidence: 99%

“…8,9 Opioid analgesics are considered the standard of care for postoperative pain control in bowel resection patients, but opioids can contribute to the development of POI. 8 By binding to the mu-opioid receptor in the GI tract, opioids can slow gastrointestinal transit, inhibit intestinal ion and fluid secretion, cause nonpropulsive segmental contractions of the small and large intestine, and impair the ability to defecate. 9,10 Surgery also triggers the release of endogenous opioids that have the ability to behave as exogenous opioids and prolong the ileus.…”

mentioning

confidence: 99%

An Evaluation of Alvimopan Use as Part of Perioperative Management of Patients Undergoing Laparoscopic Small and Large Bowel Resections

et al. 2011

View full text Add to dashboard Cite

Objective: Delayed gastrointestinal (GI) recovery (postoperative ileus) is a risk for patients undergoing bowel resection (BR) and presents clinical challenges including prolonged hospital length of stay (LOS) and increased postoperative morbidity. Alvimopan, an oral, peripherally acting mu-opioid receptor antagonist, is the first therapy approved to accelerate GI recovery after BR. Published data have described alvimopan use in open BR. In contrast, this study focused on laparoscopic BR. Methods: Historic data were retrospectively collected and alvimopan data were prospectively collected from 1 surgeon at our facility. Adults undergoing laparoscopic partial small or large BR with primary anastamosis scheduled to receive intravenous, opioid-based, patient-controlled analgesia were eligible. Pregnancy, opioid analgesic on the home medication reconciliation form, complete bowel obstruction, colostomy or ileostomy creation, and unplanned surgery were exclusion criteria. All patients were uniformly managed with a standardized accelerated postoperative care pathway to facilitate GI recovery. LOS, time to first bowel movement (BM), 30-day readmission rate, and the cost were evaluated. Data were analyzed using Pearson chi-square and independent samples t tests.Results: Thirty-nine alvimopan and 56 historic cohort patients were included. Time to first BM was reduced by 1.2 days and LOS was reduced by 1.1 days (both P , .001) in the alvimopan cohort compared with control. Overall variable cost data were reduced by $1,368 in the alvimopan cohort. Readmission rates were low and comparable. Conclusions: Laparoscopic surgery can decrease LOS compared with open BR; however, alvimopan use at our facility reduced LOS and time to BM while remaining cost-effective in this patient population.

show abstract

Alvimopan for postoperative ileus

Cited by 36 publications

References 38 publications

Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries

Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries

Off-label uses of alvimopan and methylnaltrexone

An Evaluation of Alvimopan Use as Part of Perioperative Management of Patients Undergoing Laparoscopic Small and Large Bowel Resections

Contact Info

Product

Resources

About