From the Guidelines
The treatment for ileus should primarily involve a multifaceted approach to minimize postoperative ileus, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Minimally invasive surgery to reduce the risk of postoperative ileus
- Optimized fluid management to avoid fluid overload and maintain adequate hydration 1
- Opioid-sparing analgesia to minimize the risk of opioid-induced ileus
- Early mobilization to stimulate bowel function
- Early postoperative food intake to maintain intestinal function
- Laxative administration to prevent constipation
- Omission or early removal of nasogastric intubation to reduce the duration of postoperative ileus
Medications
- Alvimopan (12mg orally twice daily for up to 7 days) may be used post-operatively to counter opioid-induced ileus 1
- Prokinetic agents like metoclopramide or erythromycin may be considered, though their effectiveness varies 1
Additional Measures
- Chewing gum has been shown to have a positive effect on postoperative duration of ileus 1
- Oral magnesium oxide may promote postoperative bowel function, although the evidence is mixed 1
- Bisacodyl (10 mg, p.o.) administered twice a day from the day before surgery to the third postoperative day may improve postoperative intestinal function 1
From the FDA Drug Label
Postoperative ileus is the impairment of gastrointestinal motility after intra-abdominal surgery or other, non-abdominal surgeries. Following oral administration, alvimopan antagonizes the peripheral effects of opioids on gastrointestinal motility and secretion by competitively binding to gastrointestinal tract µ-opioid receptors.
The treatment for ileus is alvimopan (PO), which works by antagonizing the peripheral effects of opioids on gastrointestinal motility and secretion.
- Key benefits:
- Reduces the delay in small and large bowel transit induced by opioids
- Does not reverse the central analgesic effects of µ-opioid agonists
- Important considerations:
From the Research
Treatment for Ileus
The treatment for ileus can vary depending on the underlying cause and severity of the condition. Some possible treatments include:
- Medications to stimulate bowel movement, such as methylnaltrexone 3, 4, 5, 6
- Thoracic epidural analgesia to reduce pain and promote bowel function 7
- Avoidance of salt and water overload to prevent fluid buildup in the body 7
- Use of alvimopan to help restore bowel function after surgery 7, 5, 6
- Gum chewing to stimulate bowel movement and reduce the risk of postoperative ileus 7
- Minimal access surgery to reduce the risk of postoperative ileus 7
- Avoidance of nasogastric tubes to reduce the risk of postoperative ileus 7
Medication Options
Some medications that have been studied for the treatment of ileus include:
- Methylnaltrexone: a peripherally acting μ-opioid receptor antagonist that has been shown to be safe and effective in treating opioid-induced bowel dysfunction 3, 4, 5, 6
- Alvimopan: a peripherally acting μ-opioid receptor antagonist that has been shown to be safe and effective in treating postoperative ileus 7, 5, 6
- Naloxone: an opioid antagonist that has been studied for the treatment of opioid-induced bowel dysfunction, but has limited evidence to support its use 5, 6
- Nalbuphine: an opioid antagonist that has been studied for the treatment of opioid-induced bowel dysfunction, but has limited evidence to support its use 5, 6
Safety and Efficacy
The safety and efficacy of these medications have been studied in various clinical trials. Methylnaltrexone and alvimopan have been shown to be safe and effective in treating opioid-induced bowel dysfunction and postoperative ileus, respectively 3, 4, 7, 5, 6. However, further studies are needed to fully assess their place in therapy and to determine the long-term efficacy and safety of these medications.