Alvimopan as part of the Enhanced Recovery After Surgery protocol following radical cystectomy is associated with decreased hospital stay

Hanna, Peter; Regmi, Subodh; Kalapara, Arveen; Mulpuri, Kalyana Srujana; Zabell, Joseph; Albersheim, Jacob; Wahr, Joyce A.; Randle, Darrel; Kaizer, Alexander; Patten, Luke; Konety, Badrinath R.; Weight, Christopher J.

doi:10.1111/iju.14546

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…68–71 Retrospective studies using institutional as well as nationwide databases demonstrate reduced LOS and time to GI recovery with alvimopan use in RC patients. 72–74 Although alvimopan was not initially included in the 2013 ERAS guidelines, it has been increasingly adapted into protocols following a RC-specific multicenter RCT published by Lee et al . 75 This study found that patients randomized to alvimopan ( n = 143) had reduced time to GI recovery (5.5 vs 6.8 days, HR 1.8, p < 0.0001), mean LOS (7.4 vs 10.1 days, p = 0.0051), NGT insertion (7.7 vs 24.6%, p < 0.001), and episodes of POI-related morbidity (8.4 vs 29.1%, p < 0.001) than patients randomized to placebo ( n = 137).…”

Section: Targeted Components Of Erasmentioning

confidence: 99%

Updates on enhanced recovery after surgery for radical cystectomy

Lee

Patel

Srivastava

et al. 2022

Therapeutic Advances in Urology

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Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.

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Section: Targeted Components Of Erasmentioning

confidence: 99%

Updates on enhanced recovery after surgery for radical cystectomy

Lee

Patel

Srivastava

et al. 2022

Therapeutic Advances in Urology

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“…A short-term treatment only is recommended, making alvimopan an unsuitable agent for patients on long-term opioids [60,61]. This drug could possibly serve as a part of Enhanced Recovery After Surgery protocols (ERAS) [62]. Further studies have to be undertaken in order to establish a definitive conclusion regarding cost-effectiveness, safety and effect on pain scores, as the existing results are inconclusive [63,64].…”

Section: Figure 3: Speed Of Action (Hours After Oral Administration)mentioning

confidence: 99%

Efficacy and Safety of Peripherally Acting μ-Opioid Receptor Antagonist (PAMORAs) for the Management of Patients With Opioid-Induced Constipation: A Systematic Review

Rekatsina

Paladini

Drewes

et al. 2021

Cureus

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In treating chronic and acute pain, opioids are widely used. Although they do provide analgesia, their usage does come with adverse events (AEs). One of the most burdensome is opioid-induced bowel dysfunction, and more specifically opioid-induced constipation (OIC). The pathogenesis of these AEs is well known as the consequence of the action of opioids on m-receptors in the enteric nervous system. In recent years, medicines counteracting this specific action at the receptors have been registered for clinical use: the peripherally acting μ-opioid receptor antagonists (PAMORAs). The knowledge of their comparative efficacy and tolerability is very important for physicians and patients in opioid therapy. This systematic review of the existing literature on PAMORAs aimed to study the relative clinical advantages and disadvantages.The most important data banks, including "PubMed," "Embase," "CT.gov," "ICTRP" and "CINAHL" were used to find the published material on PAMORAs. The selected publications were examined to systematically analyze the efficacy and safety of the four existing PAMORAs.All of the medications are superior to placebo in reducing OIC. There are few published data on alvimopan used to treat OIC, and it is only indicated for the treatment of post-abdominal surgery ileus. Methylnaltrexone is studied mainly in its subcutaneous (SC) formulation. When used in its oral formulation, it seems more rapid than naloxegol and placebo in the reduction of OIC. Naldemedine is able to produce more spontaneous bowel movements (SBMs) when compared to alvimopan and naloxegol.Tolerability was found to be similar for all of them. In particular, they affect the gastrointestinal tract (GI), with flatulence and diarrhea, especially at high dosages. For some of them, nasopharyngitis and abdominal pain were observed as treatment adverse effects (TEAs). Several cardiovascular TEAs were reported after methylnaltrexone use, but it is not clear whether they were consequences of the drug or related to the general conditions of the patients.Considering the existing data, naloxegol and naldemedine seem to be the best choices, with a higher number of spontaneous bowel movements following naldemedine administration.

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