Key result
Alvimopan prevents recurrent ileus and rapidly restores bowel function in a high-risk spinal fusion patient.
Why the study?
Does alvimopan prevent postoperative ileus in patients undergoing spine surgery?
Case Report (n=1)
No
Does alvimopan prevent postoperative ileus in patients undergoing spine surgery?
Alvimopan may be useful for preventing postoperative ileus in high-risk orthopedic and spine surgery patients.
Hypothesis-generating for alvimopan in high-risk spine surgery; prospective trials needed before clinical adoption.
Postoperative ileus affects a substantial proportion of patients undergoing elective spine surgery, especially in cases of spinal deformity correction and where an anterior lumbar approach is utilized. Though the first line of treatment for postoperative ileus is conservative management, recent advances in pharmacology have yielded promising options for both treatment and prevention. We report a case of a patient who underwent a two-stage posterior spinal fusion. The patient suffered with a severe, prolonged ileus after her initial surgery. To prevent ileus following her second spinal surgery, alvimopan (a µ-opioid receptor antagonist) was administered and she had a rapid return of bowel function with no signs of ileus. Alvimopan, has been shown to reduce the rate of ileus in colorectal surgery patients, and may be useful for preventing ileus in high-risk orthopedic and spine surgery patients, although prospective studies will be needed to test this hypothesis.
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Shah et al. (2015) conducted a case report in Postoperative paralytic ileus (n=1). Alvimopan was evaluated on Development of postoperative paralytic ileus and return of bowel function. Prophylactic administration of alvimopan in a high-risk patient undergoing a second-stage spinal fusion resulted in rapid return of bowel function and prevented the recurrence of postoperative ileus.
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