A. Chandrasekaran3, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2New Jersey Medical School,Surgery,Newark, NJ, USA 3Saint George’s University,Grenada, Grenada, Grenada
Introduction:
Postoperative bowel atony impedes recovery following abdominal surgery. Alvimopan is a competitive, selective µ-opioid receptor antagonist that has been extensively studied (with variable reported rates of efficacy) in regards to its ability to aid GI tract recovery in abdominal surgery patients. This meta-analysis critically examines the clinical and financial impact of impact of alvimopan on GI recovery.
Methods:
A comprehensive literature search of PubMed, Google Scholar, and the Cochrane Central Registry of Controlled Trials (1966-2015) was completed. Search terms were, ‘alvimopan’, ‘entereg’, ‘ADL 8-2698′, ‘Surgery’, and ‘randomized controlled trial’. Outcomes analyzed were time to tolerance of solid food and first bowel movement, time to hospital discharge order written, and opioid use.
Results:
Seven RCTs involving 2,955 abdominal and pelvic surgery patients receiving alvimopan 12mg versus placebo were included in this analysis. 1,644 patients received alvimopan 12mg and 1,311 received placebo two hours before the start of surgery and twice daily for seven days or until hospital discharge. 2,558 patients underwent bowel resection, 700 patients underwent total abdominal hysterectomy, 159 underwent radical hysterectomy, and 227 underwent radical cystectomy. Alvimopan 12mg was associated with a statistically significant reduction in mean time to tolerance of solid food and first bowel movement (SDM -0.326; 95% CI -0.411 to -0.240, p<0.001) as well as mean time to discharge order (SDM -0.215; 95% CI -0.301 to -0.130, p<0.001). No significant reduction in postoperative opioid use was identified in the included studies.
Conclusion:
Alvimopan significantly aids post-operative recovery after abdominal and pelvic surgery as measured by a significant decrease in return to GI function and time to hospital discharge order. No difference in opioid requirement is attributable to alvimopan use. Alvimopan should be considered an effective adjunctive aid to bowel recovery for patients undergoing abdominal or pelvic surgery. Alvimopan use in other types of surgery requires additional investigation.
