Pharmacologic Options to Prevent Postoperative Ileus

Objective: To summarize the evidence on pharmacologic options in preventing postoperative ileus (POI). Data Sources: The Cochrane Database of Reviews and OVID databases and Food and Drug Administration (FDA) Web site were searched (1950–April 2009) using the term postoperative ileus. Study Selection...

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Bibliographic Details
Published in:The Annals of pharmacotherapy 2009-09, Vol.43 (9), p.1474-1485
Main Authors: Yeh, Yu-Chen, Klinger, Elissa V, Reddy, Prabashni
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chewing Gum
Clinical Trials as Topic
Drug Costs
Gastrointestinal Agents - adverse effects
Gastrointestinal Agents - economics
Gastrointestinal Agents - therapeutic use
Humans
Ileus - etiology
Ileus - prevention & control
Medical sciences
Pharmacology. Drug treatments
Piperidines - adverse effects
Piperidines - economics
Piperidines - therapeutic use
Postoperative Care
Postoperative Complications - prevention & control
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Summary:Objective: To summarize the evidence on pharmacologic options in preventing postoperative ileus (POI). Data Sources: The Cochrane Database of Reviews and OVID databases and Food and Drug Administration (FDA) Web site were searched (1950–April 2009) using the term postoperative ileus. Study Selection and Data Extraction: Meta-analyses and randomized controlled trials were included for review. The FDA Web site was searched for clinical reviews and label information for drugs indicated for the prevention of POI. Data Synthesis: Three meta-analyses, 2 on gum-chewing and 1 on alvimopan, and 18 clinical trials were identified. Only gum chewing and alvimopan were effective in preventing POI. Gum chewing reduced the time to first flatus and bowel movement (weighted mean difference 21h, p = 0.0006 and 33h; p = 0.0002, respectively). In one meta-analysis, gum chewing significantly reduced length of stay (LOS) by 2.4 days (p < 0.00001) but this was not replicated in the second meta-analysis. Alvimopan shortened the time to reach a composite endpoint of solid food intake, plus/minus flatus, and bowel movement (93 vs 105 h; p < 0.001). A higher incidence of myocardial infarction was observed in a 12-month study of alvimopan for the treatment of opioid-induced bowel dysfunction, but not in studies in patients undergoing bowel resection. Alvimopan decreased the time to written hospital discharge order (hazard ratio 1.35; p
ISSN:1060-0280
1542-6270
DOI:10.1345/aph.1M121