• Lauren K Dunn, Robert H Thiele, Michelle C Lin, Edward C Nemergut, Marcel E Durieux, Siny Tsang, Mark E Shaffrey, Justin S Smith, Christopher I Shaffrey, and Bhiken I Naik.
• Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
• Neurosurgery. 2019 Aug 1; 85 (2): E233-E239.

BackgroundPain management following major spine surgery requires high doses of opioids and is associated with a risk of opioid-induced constipation. Peripheral mu-receptor antagonists decrease the gastrointestinal complications of perioperative systemic opioid administration without antagonizing the analgesic benefits of these drugs.ObjectiveTo investigate the impact of alvimopan in opioid-naive patients undergoing major spine surgery.MethodsPatients undergoing >3 levels of thoracic and/or lumbar spine surgery were enrolled in this prospective, randomized, double-blind study to receive either alvimopan or placebo prior to and following surgery. Opioid consumption; pain scores; and time of first oral intake, flatus, and bowel movement were recorded.ResultsA total of 24 patients were assigned to the active group and 25 were assigned to the placebo group. There was no significant difference in demographics between the groups. Postoperatively, the alvimopan group reported earlier time to first solid intake [median (range): alvimopan: 15 h (3-25) vs placebo: 17 h (3-46), P < .001], passing of flatus [median (range): alvimopan: 22 h (7-63) vs placebo: 28 h (10-58), P < .001], and first bowel movement [median (range): alvimopan: 50 h (22-80) vs placebo: 64 h (40-114), P < .001]. The alvimopan group had higher pain scores (maximum, minimum, and median); however, there was no significant difference between the groups with postoperative opioid use.ConclusionThis study shows that the perioperative use of alvimopan significantly reduced the time to return of bowel function with no increase in postoperative opioid use despite a slight increase in pain scores.Copyright © 2019 by the Congress of Neurological Surgeons.

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