1590 THE NOVEL OPIOID RECEPTOR ANTAGONIST ALVIMOPAN MINIMIZES POST-OPERATIVE ILEUS FOLLOWING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 20121590 THE NOVEL OPIOID RECEPTOR ANTAGONIST ALVIMOPAN MINIMIZES POST-OPERATIVE ILEUS FOLLOWING RADICAL CYSTECTOMY Joel Bigley, Jeffrey Tomaszewski, Jeffrey Gingrich, Benjamin Davies, and Ronald Hrebinko Joel BigleyJoel Bigley Pittsburgh, PA More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski Pittsburgh, PA More articles by this author , Jeffrey GingrichJeffrey Gingrich Pittsburgh, PA More articles by this author , Benjamin DaviesBenjamin Davies Pittsburgh, PA More articles by this author , and Ronald HrebinkoRonald Hrebinko Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-operative ileus contributes significantly to the morbidity associated with radical cystectomy and urinary diversion (RCx). Alvimopan (Entereg) is a novel peripherally acting μ-opioid receptor antagonist approved by the FDA to accelerate upper and lower gastrointestinal recovery in the management of postoperative ileus following bowel resection. Our objective was to evaluate the effect of alvimopan on time to return of bowel function and hospital length of stay in a retrospective matched-cohort analysis of patients undergoing radical cystectomy. METHODS 24 consecutive patients who had undergone RCx and received perioperative alvimopan were matched chronologically for surgeon and type of urinary diversion (1:2) to patients not receiving alvimopan (n=48). Patients in the treatment group received alvimopan 12mg twice daily until hospital discharge. Patients were excluded if they had undergone radical cystectomy as part of a larger surgical oncology operation or did not survive to hospital discharge. Primary outcomes of interest included time to GI-2 (toleration of solid food and first bowel movement) and GI-3 (toleration of solid food and first flatus or bowel movement) recovery, hospital discharge order written, actual hospital discharge, opioid consumption, and overall postoperative ileus-related morbidity. Categorical and linear variables were compared using Fisher's exact and Mann Whitney U tests, respectively. RESULTS There was no significant differences in mean patient age, gender distribution, type of urinary diversion, or PCA usage between groups. There were no significant side effects reported in patients receiving alvimopan. Alvimopan significantly decreased time to return of bowel function (GI-2: 104±33hr vs. 142 ± 53hr, p<0.01; GI-3: 102±34hr vs. 140±53hr, p<0.01). Hospital length of stay was significantly shorter in patients treated with alvimopan (5.8±1.3d vs. 7.5±2.9d, p<0.05). The 30-day readmission rate for vomiting, adynamic ileus, or partial small bowel obstruction in patients receiving alvimopan was 0% compared to 10.4% in the control group. CONCLUSIONS Consistent with clinical trial data in general surgery series, alvimopan use following radical cystectomy shortened hospital length of stay and decreased time to return of bowel function by approximately 1.5 days. These results support the clinical benefit of alvimopan in patients undergoing radical cystectomy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e643-e644 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joel Bigley Pittsburgh, PA More articles by this author Jeffrey Tomaszewski Pittsburgh, PA More articles by this author Jeffrey Gingrich Pittsburgh, PA More articles by this author Benjamin Davies Pittsburgh, PA More articles by this author Ronald Hrebinko Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...