Alvimopan for post-radical cystectomy ileus: what should we know?

Post-operative ileus is a significant issue encountered by numerous patients following radical cystectomy and urinary diversion. It can contribute to prolonged length of hospital stay, increased post-operative morbidity and significant patient discomfort (1). The causes of POI are multifactorial and include manipulation of the gastrointestinal tract due to bowel resection and re-anastomosis, inflammatory mediators, electrolyte imbalances, and use of systemic opioids. Traditional opioids, which bind to mu receptors in the gut, currently play a key role in post-operative pain management after radical cystectomy and can contribute to the development of POI. Prophylactic measures to prevent POI such as the use of prokinetic agents like metoclopramide, use of regional anaesthesia and aggressive and early ambulation post operatively are practiced routinely to expedite gut functioning (2,3).