Abstract
Introduction and Background- Bowel obstruction poses a considerable medical dilemma, demanding swift identification and intervention due to its propensity for severe complications. This challenge is exacerbated in elderly individuals who may be frail and less amenable to surgical interventions. Alvimopan, a peripherally acting μ-opioid receptor antagonist renowned for its pro-kinetic effects on the bowel, has shown promise in clinical trials. Nevertheless, despite its efficacy, it remains underutilised in many clinical hospital settings. Thus, our systemic review aims to underscore the potential benefits of Alvimopan, reintroducing its significance in managing bowel obstruction, particularly in elderly patients.
Methods- Four databases were searched to identify relevant studies investigating the use of Alvimopan for treating ileus. Included studies measured time for first bowel motion, and was compared with controls. Animal and non-original research articles were excluded.
Results- Ten randomised controlled trials (RCTs) were incorporated, each showcasing the significant reduction in both time to initial bowel movement and hospital stay attributed to Alvimopan. Findings indicated that Alvimopan can decrease the duration until the first bowel movement by an average of 14 hours compared to placebo, as well as abbreviate the time until discharge by an average of six hours.
Conclusion- Consistently, Alvimopan has demonstrated favourable results for patients experiencing bowel obstruction. Its utilisation could potentially circumvent the necessity for laparotomy in frail patients. Moreover, employing this medication contributes to shorter hospital stays, thus potentially mitigating associated complications. Consequently, we strongly advocate for its use and advocate for additional research to incorporate it into clinical guidelines.