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Alvimopan retains efficacy in patients undergoing colorectal surgery within an established ERAS program

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Abstract

Background

Post-operative ileus and delayed return of gastrointestinal function are complications seen frequently in patients undergoing colorectal surgery. Many enhanced recovery after surgery protocols include alvimopan to inhibit the effects of opiates in the gastrointestinal tract and lidocaine to augment analgesics. Limited data exist regarding alvimopan’s efficacy in opiate-sparing regimens.

Methods

This single-center, retrospective cohort analysis was conducted in a randomly selected population of adult patients undergoing colorectal resection between February 2018 and October 2019. Patients meeting inclusion criteria were divided into four groups dependent upon whether or not they received alvimopan (A or a) and/or lidocaine (L or l). The primary endpoint in this study was median time to first bowel movement or discharge, whichever came first. Our secondary endpoint was length of stay.

Results

Of the 430 patients evaluated, a total of 192 patients were included in the final evaluation in the following groups: AL (n = 93), Al (n = 34), aL (n = 44), and al (n = 21). A significant difference was found among the groups for the primary outcome of median time to bowel movement or discharge (p = 0.001). Three subsequent pair-wise comparisons resulted in a significant difference in the primary outcome: group AL 39.4 h vs. group aL 54.0 h (p = 0.003), group AL 39.4 h vs. group al 55.4 h (p = 0.001), and group Al 44.9 h vs. group al 55.4 h (p = 0.01). Length of stay was significantly reduced by 1.8 days in groups AL and Al compared to group aL (p < 0.001).

Conclusion

Treatment with alvimopan resulted in a significant improvement in time to GI recovery and decreased length of stay in an established ERAS program. While lidocaine’s reduction in opiates was minimal, the group receiving both alvimopan and lidocaine had the greatest reduction in time to GI recovery and length of stay.

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Acknowledgements

The authors thank Sydney Holmes, PharmD Candidate 2021 (University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee, USA) for her assistance with data collection.

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Authors and Affiliations

  1. University of Tennessee Medical Center, Knoxville, TN, USA

    Skyler Brown & John R. Yates

  2. University of Tennessee Medical Center, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA

    James McLoughlin, Andrew Russ, Mark Casillas, Jason Buehler & Robert E. Heidel

  3. Department of Pharmacy, University of Tennessee Medical Center, 1924 Alcoa Hwy, Box 41, Knoxville, TN, 37920, USA

    Skyler Brown & John R. Yates

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  1. Skyler Brown
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  2. James McLoughlin
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Correspondence to John R. Yates.

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Skyler Brown, James McLoughlin, Andrew Russ, Mark Casillas, Jr., Jason Buehler, Robert H. Heidel, and John R. Yates have no conflicts of interest or financial ties to disclose.

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Brown, S., McLoughlin, J., Russ, A. et al. Alvimopan retains efficacy in patients undergoing colorectal surgery within an established ERAS program. Surg Endosc 36, 6129–6137 (2022). https://doi.org/10.1007/s00464-021-08928-7

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