Faculty Collaboration Database

Alvimopan for the management of postoperative ileus after bowel resection: characterization of clinical benefit by pooled responder analysis. World J Surg 2010 Sep;34(9):2185-90

Date

06/08/2010

Pubmed ID

20526599

Pubmed Central ID

PMC2917559

DOI

10.1007/s00268-010-0635-9

Scopus ID

2-s2.0-79952113772 (requires institutional sign-in at Scopus site)   36 Citations

Abstract

BACKGROUND: A pooled post hoc responder analysis was performed to assess the clinical benefit of alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist, for the management of postoperative ileus after bowel resection.

METHODS: Adult patients who underwent laparotomy for bowel resection scheduled for opioid-based intravenous patient-controlled analgesia received oral alvimopan or placebo preoperatively and twice daily postoperatively until hospital discharge or for 7 postoperative days. The proportion of responders and numbers needed to treat (NNT) were examined on postoperative days (POD) 3-8 for GI-2 recovery (first bowel movement, toleration of solid food) and hospital discharge order (DCO) written.

RESULTS: Alvimopan significantly increased the proportion of patients with GI-2 recovery and DCO written by each POD (P < 0.001 for all). More patients who received alvimopan achieved GI-2 recovery on or before POD 5 (alvimopan, 80%; placebo, 66%) and DCO written before POD 7 (alvimopan, 87%; placebo, 72%), with corresponding NNTs equal to 7.

CONCLUSIONS: On each POD analyzed, alvimopan significantly increased the proportion of patients who achieved GI-2 recovery and DCO written versus placebo and was associated with relatively low NNTs. The results of these analyses provide additional characterization and support for the overall clinical benefit of alvimopan in patients undergoing bowel resection.

Author List

Ludwig K, Viscusi ER, Wolff BG, Delaney CP, Senagore A, Techner L

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Colonic Neoplasms
Digestive System Surgical Procedures
Diverticulosis, Colonic
Female
Humans
Ileus
Intestines
Length of Stay
Male
Middle Aged
Piperidines
Postoperative Complications
Receptors, Opioid, mu
Recovery of Function
Rectal Neoplasms
Treatment Outcome