Princess Alexandra Hospital NHS Foundation Trust, Harlow, UK.
, Buckleigh road, Streatham, UK.
Langenbecks Arch Surg. 2024 Sep 13;409(1):278. doi: 10.1007/s00423-024-03462-1.
Postoperative ileus (POI) is a common complication following abdominal surgery, often leading to extended hospital stays and a higher risk of post-operative complications, leading to poorer patient outcomes. Alvimopan, a peripherally acting µ-opioid receptor antagonist, has been shown to aid in the recovery of normal bowel function after surgery. While its benefits are well-established in open abdominal surgeries, its efficacy in laparoscopic procedures had not been conclusively determined. However, recent clinical trials involving laparoscopic surgeries have since been conducted. This review aims to reassess the efficacy of Alvimopan by incorporating findings from these new studies, potentially providing further insight into its clinical benefits.
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.
Ten studies met the inclusion criteria, with seven focusing on the use of Alvimopan in open abdominal surgeries and three in laparoscopic procedures. Collectively, these studies involved 18,822 patients undergoing various types of abdominal Administration of Alvimopan 6 mg accelerated gastrointestinal function recovery by an average of 14 h (Hazard ratio: 1.62, p = 0.002) and reduced hospital stays by 5.2 h (Hazard ratio: 1.52, p = 0.04) compared to placebo. Similarly, Alvimopan 12 mg reduced GI-3 recovery time by 13.5 h (Hazard ratio: 1.58, p = 0.02) and hospital stay duration by 6.2 h (Hazard ratio: 1.46, p = 0.018).
Alvimopan shows promise in reducing POI and hospital stay durations following abdominal surgeries. The incorporation of the recent studies in laparoscopic abdominal procedures further supports these findings. Integrating Alvimopan into perioperative care protocols may enhance patient outcomes and help lower healthcare costs.
术后肠梗阻（POI）是腹部手术后的一种常见并发症，常导致住院时间延长，术后并发症风险增加，从而导致患者预后较差。阿片受体外周拮抗剂奥曲肽可促进术后肠道功能恢复。虽然奥曲肽在开腹手术中的疗效已得到证实，但在腹腔镜手术中的疗效尚未得到明确。然而，最近已经开展了涉及腹腔镜手术的临床试验。本综述旨在通过纳入这些新研究的结果，重新评估阿片受体拮抗剂的疗效，从而为其临床获益提供更多的见解。
对 PubMed、Google Scholar、EMBASE 和 Cochrane Library 进行全面检索。根据 PICO 框架纳入研究，重点关注奥曲肽对术后胃肠道恢复的影响。主要结局为胃肠功能恢复时间（GI-3）和住院时间。
纳入了 10 项研究，其中 7 项研究关注奥曲肽在开腹手术中的应用，3 项研究关注腹腔镜手术中的应用。这些研究共纳入了 18822 名接受各种类型腹部手术的患者。与安慰剂相比，奥曲肽 6mg 可平均提前 14 小时（风险比：1.62，p=0.002）恢复胃肠功能，减少 5.2 小时（风险比：1.52，p=0.04）的住院时间；奥曲肽 12mg 可使 GI-3 恢复时间缩短 13.5 小时（风险比：1.58，p=0.02），住院时间缩短 6.2 小时（风险比：1.46，p=0.018）。
奥曲肽可减少腹部手术后 POI 和住院时间。纳入腹腔镜腹部手术的最近研究进一步支持了这些发现。将奥曲肽纳入围手术期护理方案可能会改善患者的预后，并有助于降低医疗保健成本。
