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Efficacy of Alvimopan Use in Patients Undergoing an Intestinal Anastomosis
Samantha R. Paglinco, Zoltan H. Nemeth*, Rolando Rolandelli
Surgery, Morristown Medical Cennter, Morristown, NJ
Background: Surgery for the alimentary tract is associated with varying degrees of postoperative ileus. One of the causes of prolonged ileus is the administration of opioid analgesia. In order to overcome the effect of opioids on gastrointestinal motility, a peripheral µ-opioid antagonist has been developed: Alvimopan (Entereg™). This drug is effective as a peripherally acting μ-opioid antagonist. We performed a retrospective study to examine the efficacy of Alvimopan.
Methods: From 2010 to 2013, 55 patients undergoing an intestinal anastomosis at Morristown Medical Center (MMC) received Alvimopan. Patients who received Alvimopan were matched to appropriate controls for age, gender, diagnoses, and surgical approach (open versus laparoscopic) and technique of anastomosis (stapled versus hand-sewn). Controls were sought from an existing database kept at MMC for all intestinal anastomoses. Some Alvimopan receiving patients were matched with multiple controls, because multiple controls were similar to those Alvimopan using patients.
Results: The average time for return of bowel function for all patients was 67.9 hours with no difference (p=0.8251) between those who received Alvimopan (68.5 hours) and control patients (67.3 hours). The average length of hospital stay for patients who received Alvimopan was 4.6 days versus 4.8 days for control patients (p=0.7198). However, the average hospital charges for patients who received Alvimopan was \,705.15 which was significantly higher than the hospital costs of patients (\,068.80) who did not receive Alvimopan (**p=0.0080, two-tailed student t-test).
Conclusions: In patients who underwent an intestinal anastomosis, postoperative analgesia with Alvimopan did not shorten either the return of bowel function or the length of hospital stay. However, the cost of hospitalization was significantly increased by the use of Alvimopan. Postoperative ileus is a multifactorial phenomenon in which the effect of opioids on motility does not seem to be of great significance.
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