Liang-Liang Xu1, Xiao-Qin Zhou2, Peng-Sheng Yi1, Ming Zhang1, Jing Li2, Ming-Qing Xu3. 1. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. 2. Chinese Evidence-based Medicine Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. 3. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. Electronic address: xumingqing0018@163.com.
Abstract
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). Safety end points included GI-related, non-GI-related, and serious adverse events. These parameters were all analyzed by RevMan 5.3 software. RESULTS: Nine randomized controlled trials involving 4075 patients were enrolled in this study. The pooled results showed that alvimopan significantly decreased the time to GI-2 recovery (6 mg, hazard ratio [HR] = 1.45, P < 0.00001; 12 mg, HR = 1.59, P < 0.00001), BM (6 mg, HR = 1.54, P < 0.00001; 12 mg, HR = 1.74, P = 0.0002), and the time to discharge order written (6 mg, HR = 1.37, P < 0.00001; 12 mg, HR = 1.34, P < 0.00001) compared with the placebo group. However, SF was significantly reduced in 6 mg group (HR = 1.23, P = 0.008) rather than 12 mg group (HR = 1.14, 95% confidence interval 1.00, 1.30, P = 0.04). The incidence of some GI-related and serious adverse events were significantly lower in the alvimopan group than the placebo group, and the dose of 12 mg was superior to 6 mg in this regard. CONCLUSIONS: Alvimopan can accelerate recovery of GI function (especially for the lower GI tract), shorten the length of hospital stay, and reduce postoperative ileus-related morbidity without compromising opioid analgesia in an enhanced recovery setting.
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). Safety end points included GI-related, non-GI-related, and serious adverse events. These parameters were all analyzed by RevMan 5.3 software. RESULTS: Nine randomized controlled trials involving 4075 patients were enrolled in this study. The pooled results showed that alvimopan significantly decreased the time to GI-2 recovery (6 mg, hazard ratio [HR] = 1.45, P < 0.00001; 12 mg, HR = 1.59, P < 0.00001), BM (6 mg, HR = 1.54, P < 0.00001; 12 mg, HR = 1.74, P = 0.0002), and the time to discharge order written (6 mg, HR = 1.37, P < 0.00001; 12 mg, HR = 1.34, P < 0.00001) compared with the placebo group. However, SF was significantly reduced in 6 mg group (HR = 1.23, P = 0.008) rather than 12 mg group (HR = 1.14, 95% confidence interval 1.00, 1.30, P = 0.04). The incidence of some GI-related and serious adverse events were significantly lower in the alvimopan group than the placebo group, and the dose of 12 mg was superior to 6 mg in this regard. CONCLUSIONS:Alvimopan can accelerate recovery of GI function (especially for the lower GI tract), shorten the length of hospital stay, and reduce postoperative ileus-related morbidity without compromising opioid analgesia in an enhanced recovery setting.
Authors: Adam D Farmer; Asbjørn M Drewes; Giuseppe Chiarioni; Roberto De Giorgio; Tony O'Brien; Bart Morlion; Jan Tack Journal: United European Gastroenterol J Date: 2018-12-14 Impact factor: 4.623
Authors: Rioko K Sakata; Roclides C de Lima; Jose A Valadão; Plinio C Leal; Ed Cr Moura; Vitor P Cruz; Caio Mb de Oliveira Journal: Obes Surg Date: 2020-04 Impact factor: 4.129
Authors: Mohsen Alhashemi; Julio F Fiore; Nadia Safa; Mohammed Al Mahroos; Juan Mata; Nicolò Pecorelli; Gabriele Baldini; Nandini Dendukuri; Barry L Stein; A Sender Liberman; Patrick Charlebois; Franco Carli; Liane S Feldman Journal: Surg Endosc Date: 2018-10-17 Impact factor: 4.584
Authors: Martin Wagner; Pascal Probst; Michael Haselbeck-Köbler; Johanna M Brandenburg; Eva Kalkum; Dominic Störzinger; Jens Kessler; Joe J Simon; Hans-Christoph Friederich; Michaela Angelescu; Adrian T Billeter; Thilo Hackert; Beat P Müller-Stich; Markus W Büchler Journal: Ann Surg Date: 2022-01-27 Impact factor: 13.787