title: Efficacy of alvimopan following bowel resection: a comparison of two dosing strategies.
abstract: BACKGROUND
  Alvimopan is indicated to accelerate the time to gastrointestinal recovery following partial bowel resection with primary anastomosis. The approved dosing regimen includes an initial dose prior to surgery and 12 mg twice daily after surgery for up to 7 days; however, there are no human studies evaluating the need for the preoperative dose. We report our experience with gastrointestinal recovery when the preoperative dose is omitted.
  
  
  OBJECTIVE
  To evaluate the efficacy of alvimopan therapy when the preoperative dose is not administered.
  
  
  METHODS
  This retrospective study included elective surgery patients who underwent bowel resection with primary anastomosis without colostomy or ileostomy. The study compared (a) patients who received alvimopan and received a dose preoperatively, (b) patients who received alvimopan but did not receive a dose preoperatively, and (c) matched control patients who did not receive alvimopan. Length of stay following bowel resection, direct hospital costs, time to first bowel movement, and time to oral diet were evaluated.
  
  
  RESULTS
  Of 50 patients who received alvimopan, 27 received the preoperative dose and 23 did not. These 50 patients were matched to similar control patients who received no alvimopan during their admission for resection. Compared with controls, time to discharge was significantly shorter in patients who received alvimopan, regardless of whether the preoperative dose was administered (P < .001) or omitted (P = .03). Patients who did not receive the preoperative dose still experienced faster time to first bowel movement (71 vs 97 hours; P = .006) and faster time to first diet (17 vs 54 hours; P < .001) than non-alvimopan users.
  
  
  CONCLUSIONS
  Patients receiving the approved alvimopan dosing regimen experienced the most rapid recovery of gastrointestinal function. However, administering alvimopan only postoperatively (if the preoperative dose is omitted) may still reduce the severity of postoperative ileus.
authors.affiliation: University of Louisville Health Care, Louisville, KY, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Winegar
authors.forename: Mark
authors.initials: M
authors.lastname: Cox
authors.forename: Daniel
authors.initials: D
authors.lastname: Truelove
authors.forename: Guy
authors.initials: G
authors.lastname: Brock
authors.forename: Noah
authors.initials: N
authors.lastname: Scherrer
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: Pass
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control*; D007420:Intestine, Large / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan
keywords: alvimopan; anastomosis; bowel resection; ileus; preoperative dose