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 .
Phase III Trial of Alvimopan, a Novel, Peripherally Acting, Mu Opioid Antagonist, for Postoperative Ileus After Major Abdominal Surgery
PURPOSE Postoperative ileus presents significant clinical challenges that potentially prolong hospital stay , contribute to readmission , and increase morbidity . There is no approved treatment for postoperative ileus . Alvimopan is a novel , peripherally acting , mu opioid receptor antagonist currently in development for the management of postoperative ileus . METHODS Patients undergoing partial colectomy or simple or radical hysterectomy were r and omized to receive alvimopan 6 mg ( n = 152 ) , alvimopan 12 mg ( n = 146 ) , or placebo ( n = 153 ) orally 2 hours before surgery and twice daily thereafter until discharge or for up to seven days . The primary efficacy end point , time to return of gastrointestinal function , was a composite measure of passage of flatus or stool and tolerating solid food . Secondary end points included time to the hospital discharge order written . Adverse events were monitored throughout the study . RESULTS Mean time to gastrointestinal recovery was significantly reduced in patients treated with alvimopan 6 mg vs. placebo ( hazard ratio = 1.45 ; P = 0.003 ) , with a smaller reduction seen with alvimopan 12 mg ( hazard ratio = 1.28 ; P = 0.059 ) . Mean time to the hospital discharge order written was significantly accelerated in patients treated with alvimopan 6 mg ( hazard ratio = 1.50 ; P < 0.001 ) . The most common treatment-emergent adverse events across all treatment groups were nausea , vomiting , and hypotension ; the incidence of nausea and vomiting was reduced by 53 percent in the alvimopan 12-mg group . CONCLUSIONS In patients undergoing major abdominal surgery , alvimopan accelerated gastrointestinal recovery and time to the hospital discharge order written compared with placebo and was well tolerated
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 .