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Joseph V Pergolizzi, Robert B Raffa, Marco Pappagallo, Charles Fleischer, Joseph Pergolizzi, Gianpietro Zampogna, Elizabeth Duval, Janan Hishmeh, Jo Ann LeQuang, Robert Taylor
Opioid-induced constipation (OIC), a prevalent and distressing side effect of opioid therapy, does not reliably respond to treatment with conventional laxatives. OIC can be a treatment-limiting adverse event. Recent advances in medications with peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, naloxegol, and alvimopan, hold promise for treating OIC and thus extending the benefits of opioid analgesia to more chronic pain patients. Peripherally acting μ-opioid receptor antagonists have been clinically tested to improve bowel symptoms without compromise to pain relief, although there are associated side effects, including abdominal pain...
2017: Patient Preference and Adherence
Yuxiang Wen, Murad A Jabir, Michael Keating, Alison R Althans, Justin T Brady, Bradley J Champagne, Conor P Delaney, Scott R Steele
BACKGROUND: Postoperative ileus (POI) is a major cause of morbidity, increased length of stay (LOS) and hospital cost after colorectal surgery. Alvimopan is a µ-opioid antagonist used to accelerate upper and lower gastrointestinal function after bowel resection. We hypothesized that alvimopan would reduce LOS in patients undergoing colorectal resection with stoma, a situation that has not been evaluated. METHODS: A retrospective review (2010-2015) identified 58 patients who underwent colorectal resection for benign or malignant disease with stoma creation and received alvimopan...
December 7, 2016: Surgical Endoscopy
Abhijit Nair
Alvimopan is an US-FDA approved, peripherally acting mu opioid receptor antagonist which when started pre-operatively has been shown to hasten intestinal motility and reduce the duration of post-operative ileus. However the logistics involved in procuring, storing and dispensing the drug and the cost of the drug for fifteen doses as approved by FDA prohibits the use of it on a regular basis.
September 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
Vignesh T Packiam, Vijay A Agrawal, Joseph J Pariser, Andrew J Cohen, Charles U Nottingham, Shane M Pearce, Norm D Smith, Gary D Steinberg
PURPOSE: Alvimopan has decreased ileus and need for nasogastric tube (NGT) after radical cystectomy (RC). However, the natural history of ileus versus intestinal obstruction in patients receiving alvimopan is not well defined. We sought to examine the implications of NGT placement before and after the introduction of alvimopan for RC patients. METHODS: Retrospective review identified 278 and 293 consecutive patients who underwent RC before and after instituting alvimopan between June 2009 and May 2014...
July 30, 2016: World Journal of Urology
Liang-Liang Xu, Xiao-Qin Zhou, Peng-Sheng Yi, Ming Zhang, Jing Li, Ming-Qing Xu
BACKGROUND: To assess the efficacy and safety of alvimopan in conjunction with enhanced recovery strategy, compared with this strategy alone, in management of postoperative ileus in patients undergoing open abdominal surgery. METHODS: Electronic databases were comprehensively searched for relevant randomized controlled trials. We were interested in doses of 6 and 12 mg. The efficacy end points included the time to recovery of full gastrointestinal (GI) function (a composite end point measured by the time to first toleration of solid food [SF] and the time to first passage of stool, GI-2), the recovery of upper (SF) or the lower (the time to first bowel movement, BM) GI function, and the length of hospital stay (the time to discharge order written)...
June 1, 2016: Journal of Surgical Research
Mohamed Abdelgadir Adam, Zhifei Sun, Jina Kim, Julie K M Thacker
No abstract text is available yet for this article.
June 8, 2016: Annals of Surgery
Deborah S Keller, Juan-Ramon Flores-Gonzalez, Sergio Ibarra, Ali Mahmood, Eric M Haas
BACKGROUND: Alvimopan's goal is to minimize postoperative ileus and optimize outcomes; however, evidence in laparoscopic surgery is lacking. Our goal was to evaluate the benefit of alvimopan in laparoscopic colorectal surgery with an enhanced recovery pathway (ERP). METHODS: Laparoscopic colorectal cases were stratified into alvimopan and control cohorts, then case-matched for comparability. All followed an identical ERP. The main outcomes were length of stay, complications, readmissions, and costs in the alvimopan and control groups...
November 2016: American Journal of Surgery
Henrik Kehlet
No abstract text is available yet for this article.
May 26, 2016: Annals of Surgery
Anne P Ehlers, Vlad V Simianu, Amir L Bastawrous, Richard P Billingham, Giana H Davidson, Alessandro Fichera, Michael G Florence, Raman Menon, Richard C Thirlby, David R Flum, Farhood Farjah
BACKGROUND: Randomized trials have found that alvimopan hastens return of bowel function and reduces length of stay (LOS) by 1 day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and its impact on hospital costs remain uncertain. STUDY DESIGN: We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington state (2009 to 2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System)...
May 2016: Journal of the American College of Surgeons
T M Drake, A E Ward
BACKGROUND: Prolonged ileus is a common complication following gastrointestinal surgery, with an incidence of up to 40 %. Investigations examining pharmacological treatment of ileus have proved largely disappointing; however, recently, several compounds have been shown to have benefited when used as prophylaxis to prevent ileus. OBJECTIVE: This review aimed to evaluate the safety and efficacy of compounds which have been recently developed or repurposed to reduce bowel recovery time, thereby preventing ileus...
June 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
William H McRae, LaShondria Simpson-Camp, Patrick F Hammen, Hasan K Al-Sayegh
No abstract text is available yet for this article.
February 2015: American Surgeon
William H McRae, LaShondria Simpson-Camp, Patrick F Hammen, Hasan K Al-Sayegh
No abstract text is available yet for this article.
February 2015: American Surgeon
Kalpit N Shah, Gregory Waryasz, J Mason DePasse, Alan H Daniels
Postoperative ileus affects a substantial proportion of patients undergoing elective spine surgery, especially in cases of spinal deformity correction and where an anterior lumbar approach is utilized. Though the first line of treatment for postoperative ileus is conservative management, recent advances in pharmacology have yielded promising options for both treatment and prevention. We report a case of a patient who underwent a two-stage posterior spinal fusion. The patient suffered with a severe, prolonged ileus after her initial surgery...
September 28, 2015: Orthopedic Reviews
Yu Cui, Hequn Chen, Lin Qi, Xiongbing Zu, Yang Li
PURPOSE: The aim of the study was to evaluate the efficacy of alvimopan on accelerates gastrointestinal recovery after radical cystectomy. METHODS: We searched for all studies investigating alvimopan for bladder cancer patients undergoing radical cystectomy in Pubmed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. All studies that compared alvimopan with control group for patients undergoing radical cystectomy were included...
January 2016: International Journal of Surgery
Janet E Baack Kukreja, Edward M Messing, Jay B Shah
PURPOSE: The concept of enhanced recovery after surgery has been around since the 1990s when it was first introduced as a means to improve postoperative recovery of general surgical patients. In the field of urology, the uptake of enhanced recovery pathways has been slow for unclear reasons. Recently, interest in enhanced recovery after cystectomy (ERAC) has been increasing, but the current urologic oncology practice patterns remain unclear. In this study, we investigate modern perioperative patterns of care and rates of application of ERAC principles by cystectomy surgeons...
March 2016: Urologic Oncology
Justin T Brady, Eslam M G Dosokey, Benjamin P Crawshaw, Scott R Steele, Conor P Delaney
Transient ileus is a normal physiologic process after surgery. When prolonged, it is an important contributor to postoperative complications, increased length of stay and increased healthcare costs. Efforts have been made to prevent and manage postoperative ileus; alvimopan is an oral, peripheral μ-opioid receptor antagonist, and the only currently US FDA-approved medication to accelerate the return of gastrointestinal function postoperatively.
2015: Expert Review of Gastroenterology & Hepatology
Mellar Davis, Pamela Gamier
Constipation is common in the general population and for those on opioids and/or who are suffering from advanced cancer. Self-management consists of dietary changes, exercise, and laxatives. However, responses to self-management efforts are often inadequate to relieve the subjective and objective experience of constipation. Multiple new anti-constipating medications have recently been tested in randomized trials and the following are available commercially: probiotics, prucalopride, lubiprostone, linaclotide, elobixibat, antidepressants, methylnaltrexone, alvimopan, and naloxegol...
December 2015: Current Oncology Reports
Sam H Ahmedzai, Jason W Boland
INTRODUCTION: Constipation is a common adverse effect of opioids. As an example, constipation is reported in 52% of people with advanced malignancy, and this figure rises to 87% in people who are terminally ill and taking opioids. There is no reason to believe that people with chronic non-malignant disease who are prescribed opioids will be any less troubled by this adverse effect. METHODS AND OUTCOMES: We conducted a systematic overview and aimed to answer the following clinical question: What are the effects of opioid antagonists for constipation in people prescribed opioids? The population we studied included people with any condition, although most studies were in people with cancer pain...
2015: Clinical Evidence
Stephanie R Earnshaw, Teresa L Kauf, Cheryl McDade, Michele H Potashman, Cassandra Pauyo, Emily S Reese, Anthony Senagore
BACKGROUND: Prolonged postoperative ileus (POI) is the predominant cause of extended hospitalization after bowel resection surgery. Alvimopan accelerates gastrointestinal recovery, potentially reducing health care costs. We examined the value of alvimopan in reducing prolonged POI and length of stay for patients undergoing abdominal surgery using different definitions of POI. STUDY DESIGN: We developed a decision analytic model to examine costs and outcomes associated with postoperative treatment with either an accelerated care pathway (ACP) only or alvimopan+ACP...
November 2015: Journal of the American College of Surgeons
Nicholas G Berger, Timothy J Ridolfi, Kirk A Ludwig
Postoperative Ileus (POI), which occurs after surgical manipulation of the bowel during abdominal operations, is associated with prolonged hospital stay, increasing medical costs, and delayed advancement of enteral diet, which contributes to a significant economic burden on the healthcare system. The use of accelerated care pathways has shown to positively impact gut function, but inevitable postoperative opioid use contributes to POI. Alvimopan is a peripherally acting μ-opioid receptor antagonist designed to mitigate antimotility effects of opioids...
2015: Clinical and Experimental Gastroenterology
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