University of Tennessee Medical Center, Knoxville, TN, USA.
Department of Pharmacy, University of Tennessee Medical Center, 1924 Alcoa Hwy, Box 41, Knoxville, TN, 37920, USA.
Surg Endosc. 2022 Aug;36(8):6129-6137. doi: 10.1007/s00464-021-08928-7. Epub 2022 Jan 18.
Post-operative ileus and delayed return of gastrointestinal function are complications seen frequently in patients undergoing colorectal surgery. Many enhanced recovery after surgery protocols include alvimopan to inhibit the effects of opiates in the gastrointestinal tract and lidocaine to augment analgesics. Limited data exist regarding alvimopan's efficacy in opiate-sparing regimens.
This single-center, retrospective cohort analysis was conducted in a randomly selected population of adult patients undergoing colorectal resection between February 2018 and October 2019. Patients meeting inclusion criteria were divided into four groups dependent upon whether or not they received alvimopan (A or a) and/or lidocaine (L or l). The primary endpoint in this study was median time to first bowel movement or discharge, whichever came first. Our secondary endpoint was length of stay.
Of the 430 patients evaluated, a total of 192 patients were included in the final evaluation in the following groups: AL (n = 93), Al (n = 34), aL (n = 44), and al (n = 21). A significant difference was found among the groups for the primary outcome of median time to bowel movement or discharge (p = 0.001). Three subsequent pair-wise comparisons resulted in a significant difference in the primary outcome: group AL 39.4 h vs. group aL 54.0 h (p = 0.003), group AL 39.4 h vs. group al 55.4 h (p = 0.001), and group Al 44.9 h vs. group al 55.4 h (p = 0.01). Length of stay was significantly reduced by 1.8 days in groups AL and Al compared to group aL (p < 0.001).
Treatment with alvimopan resulted in a significant improvement in time to GI recovery and decreased length of stay in an established ERAS program. While lidocaine's reduction in opiates was minimal, the group receiving both alvimopan and lidocaine had the greatest reduction in time to GI recovery and length of stay.
术后肠梗阻和胃肠道功能延迟恢复是结直肠手术后患者常见的并发症。许多术后加速康复方案包括阿片受体拮抗剂奥曲肽以抑制胃肠道阿片类药物的作用，以及利多卡因以增强镇痛效果。关于阿片受体拮抗剂在阿片类药物节约方案中的疗效，目前的数据有限。
这是一项在 2018 年 2 月至 2019 年 10 月期间进行的单中心回顾性队列分析，在接受结直肠切除术的成年患者中随机选择人群。符合纳入标准的患者根据是否接受阿片受体拮抗剂（A 或 a）和/或利多卡因（L 或 l）分为四组。本研究的主要终点是首次排便或出院的中位时间，以先发生者为准。我们的次要终点是住院时间。
在评估的 430 名患者中，共有 192 名患者最终纳入以下四组的最终评估：AL 组（n=93）、Al 组（n=34）、aL 组（n=44）和 al 组（n=21）。各组在主要结局即排便或出院的中位时间方面存在显著差异（p=0.001）。随后进行了三次两两比较，主要结局有显著差异：AL 组 39.4 小时与 aL 组 54.0 小时（p=0.003），AL 组 39.4 小时与 al 组 55.4 小时（p=0.001），Al 组 44.9 小时与 al 组 55.4 小时（p=0.01）。与 aL 组相比，AL 组和 Al 组的住院时间分别显著缩短 1.8 天（p<0.001）。
在既定的加速康复方案中，使用阿片受体拮抗剂可显著改善胃肠道恢复时间，并缩短住院时间。虽然利多卡因对阿片类药物的减少作用较小，但同时接受阿片受体拮抗剂和利多卡因的组胃肠道恢复时间和住院时间的减少最大。
