Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .
Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery
Background Alvimopan is a peripherally acting mu-opioid receptor ( PAM-OR ) antagonist for accelerating gastrointestinal recovery after surgery . Methods Patients undergoing open laparotomy ( bowel resection , n = 418 ; hysterectomy , n = 197 ) were r and omized to receive alvimopan 6 or 12 mg or placebo orally ≥2 h before surgery and then b.i.d . until hospital discharge ( up to 7 days ) . The primary efficacy endpoint was time to gastrointestinal ( GI ) recovery ( measured by toleration of solid food and passage of flatus/stool ; GI-3 ) . Secondary endpoints included time to GI-2 recovery ( toleration of solid food and passage of stool ) and hospital discharge order written ( DCO ) . Results Alvimopan did not significantly accelerate GI-3 compared with placebo [ 6 mg : hazard ratio ( HR ) = 1.20 , p = 0.080 ; 12 mg : HR = 1.24 , p = 0.038 ) . However , after adjustment for significant covariates ( sex/surgical duration ) , benefits were significant for both doses ( 6 mg : HR = 1.24 , p = 0.037 ; 12 mg : HR = 1.26 , p = 0.028 ) . Alvimopan also significantly accelerated time to GI-2 ( 6 mg : HR = 1.37 , p = 0.008 ; 12 mg : HR = 1.33 , p = 0.018 ) and DCO ( 6 mg : HR = 1.31 , p = 0.008 ; 12 mg : HR = 1.28 , p = 0.015 ) . Adverse events were similar between groups . Conclusions Alvimopan ( 6 or 12 mg ) accelerates GI recovery and is well tolerated in patients undergoing open laparotomy
Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus .
Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence .
CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .
OBJECTIVE To present an evidence -based review of the perioperative management of the radical cystectomy ( RC ) patient in the context of a care re design initiative .