A Preliminary Investigation: Alvimopan Use to Prevent Post-Operative Ileus after Radical Cystectomy with Urinary Diversion

Abstract

Background : Postoperative ileus (POI) is a common and frustrating patient complication after a urinary diversion by using a segment of bowel. Alvimopan is an oral selective antagonist to the peripheral μ -opioid receptor. Our study investigates the effect of alvimopan on POI in patients undergoing radical cystectomy. There are no documented studies on alvimopan’s efficacy in urologic surgery literature. Methods : Approval from the Institutional Review Board was obtained to conduct a retrospective review of patients’ records from August 2009 until August 2011. The study included sixteen patients who had undergone radical cystectomy with ileal diversion. Exclusion criteria included patients with chronic opioid use, previous colostomy or ileostomy, or significant comorbidities which could cause increased postoperative complications. Statistical analysis was performed to examine the association of alvimopan use with decreased time to dietary advancement and decreased length of hospital stay. Results : The alvimopan group advanced their diet more than 24 hours earlier in comparison with the alvimopan naive group (P < 0.0433), and the alvimopan group had a greater had a greater or 26% shorter hospital length (P < 0.0451) than one day. We showed a reduced risk of POI and subsequent decreased hospital course length. There was no significant difference in readmission rate or need for nasogastric tube (NGT). Interpretation : To our knowledge we report one of the first uses of alvimopan in reducing POI in the urological surgery literature. Our novel experience with using this drug is encouraging. Further research will ultimately determine if standar d use of alvimopan to decrease POI in radical cystectomy with ileal diversion will be implemented .