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 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 standard use of alvimopan to decrease POI in radical cystectomy with ileal diversion will be implemented.
Highlights
In 2009, there were over 70,000 new diagnoses of bladder cancer and more than 14,000 deaths, making bladder cancer the 5th most common malignancy in the United States [1]
Ileus is a common occurrence leading to patient discomfort and increased length of hospital stay [2]
Statistical analysis was performed to examine the association of alvimopan use with decreased time to dietary advancement and decreased length of hospital stay
Summary
In 2009, there were over 70,000 new diagnoses of bladder cancer and more than 14,000 deaths, making bladder cancer the 5th most common malignancy in the United States [1]. Ileus is a common occurrence leading to patient discomfort and increased length of hospital stay [2]. Post-operative ileus (POI) is defined as a “transient impairment of bowel motility” [3] This condition may lead to nausea, vomiting, prolonged hospital stay, bowel distention, abdominal pain, and, in severe cases, aspiration [3,4]. Postoperative ileus (POI) is a common and frustrating patient complication after a urinary diversion by using a segment of bowel. Our study investigates the effect of alvimopan on POI in patients undergoing radical cystectomy. The study included sixteen patients who had undergone radical cystectomy with ileal diversion. Further research will determine if standard use of alvimopan to decrease POI in radical cystectomy with ileal diversion will be implemented
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