Alvimopan for post-operative ileus: What we should know
Post operative ileus is a distressing problem after gastrointestinal surgeries ( open or
laparoscopic ). It leads to a significant patient discomfort, prolonged hospital stay which
eventually adds to significant increase in overall cost of treatment. On many
occasions, ileus is the cause of readmission or re-exploration. Length of hospital stay
and discharge from the hospital is dependent on optimal bowel activity. The cause of
ileus is usually multifactorial. Bowel handling during surgery, resection and anastomosis
of intestines, surgical stress, inflammatory mediators, electrolyte imbalances, systemic
narcotics are …show more content…
Intravenous narcotics are the mainstay of post operative pain management after major
bowel surgeries. Although an epidural catheter is usually placed for providing pain
relief due to open surgeries, IV narcotics are used as a part of pain relief round the
clock or for breakthrough pain. Narcotics bind to µ receptors in the gut leading to
ileus.
Post operative ileus is a consistent problem after colorectal surgeries. In view of that,
prophylactic measures are prescribed in the post-operative orders. Prokinetics like
metoclopramide are routinely a part of the post operative orders. Intravenous
levosulpiride, neostigmine and lignocaine are used in some resistant cases. Epidural
analgesia in the perioperative period is known to enhance bowel motility. Oral
prokinetic medications like mosapride or itopride is also used although it is difficult
to say how much drug gets absorbed in presence of gastroparesis. The oral route is
used because these drugs are not available in intravenous form. Aggressive
Post operative ileus is a distressing problem after gastrointestinal surgeries ( open or
laparoscopic ). It leads to a significant patient discomfort, prolonged hospital stay which
eventually adds to significant increase in overall cost of treatment. On many
occasions, ileus is the cause of readmission or re-exploration. Length of hospital stay
and discharge from the hospital is dependent on optimal bowel activity. The cause of
ileus is usually multifactorial. Bowel handling during surgery, resection and anastomosis
of intestines, surgical stress, inflammatory mediators, electrolyte imbalances, systemic
narcotics are …show more content…
Intravenous narcotics are the mainstay of post operative pain management after major
bowel surgeries. Although an epidural catheter is usually placed for providing pain
relief due to open surgeries, IV narcotics are used as a part of pain relief round the
clock or for breakthrough pain. Narcotics bind to µ receptors in the gut leading to
ileus.
Post operative ileus is a consistent problem after colorectal surgeries. In view of that,
prophylactic measures are prescribed in the post-operative orders. Prokinetics like
metoclopramide are routinely a part of the post operative orders. Intravenous
levosulpiride, neostigmine and lignocaine are used in some resistant cases. Epidural
analgesia in the perioperative period is known to enhance bowel motility. Oral
prokinetic medications like mosapride or itopride is also used although it is difficult
to say how much drug gets absorbed in presence of gastroparesis. The oral route is
used because these drugs are not available in intravenous form. Aggressive