Alvimopan for Postoperative Ileus following Abdominal Surgery: A Systematic Review

Background Postoperative ileus (POI) is a frequent complication of abdominal surgeries, prolonging hospital stays and increasing the risk of complications, leading to poorer patient outcomes. Alvimopan, a peripherally acting µ opioid antagonist, helps restore normal bowel function post-surgery. Although clinical trials have shown its benefits, definitive guidelines for its use are lacking, leading to its underutilisation in clinical practice. Objective This review evaluates the efficacy and safety of Alvimopan in reducing the risk of POI and shortening hospital stays for patients undergoing abdominal surgeries. Methods A comprehensive search of PubMed, Google Scholar, EMBASE, and the Cochrane Library was conducted. Studies were included based on the PICO framework, focusing on Alvimopan's impact on postoperative gastrointestinal recovery. Primary outcomes were time to gastrointestinal function recovery (GI-3) and hospital stay duration. Results Ten studies met the inclusion criteria, encompassing 18,822 patients undergoing various abdominal surgeries. Administration of Alvimopan 6 mg accelerated gastrointestinal function recovery by an average of 14 hours (Hazard ratio: 1.62, p = 0.002) and reduced hospital stays by 5.2 hours (Hazard ratio: 1.52, p = 0.04) compared to placebo. Similarly, Alvimopan 12 mg reduced GI-3 recovery time by 13.5 hours (Hazard ratio: 1.58, p = 0.02) and hospital stay duration by 6.2 hours (Hazard ratio: 1.46, p = 0.018). Conclusion Alvimopan shows promise in reducing POI and hospital stay durations following abdominal surgeries. Incorporating Alvimopan into perioperative care protocols could improve patient outcomes and reduce healthcare costs. Further research is needed to evaluate its effects on laparoscopic and other surgical procedures.