Peripherally acting μ-opioid receptor antagonists have been shown to enhance gastrointestinal recovery following major abdominopelvic surgery. Among these, Alvimopan is well-studied and has demonstrated reductions in postoperative ileus, length of hospital stay (LOS), and associated healthcare costs, particularly in procedures such as radical cystoprostatectomy. Naloxegol is considerably more cost-effective than Alvimopan, but its efficacy in this surgical context remains less well established.

A retrospective cohort study was conducted at a tertiary centre, comparing 23 patients who underwent open radical cystectomy and received perioperative Naloxegol with 9 control patients between 2022 and 2024. Time to return of bowel function, incidence of postoperative ileus, length of hospital stay (LOS) and complication rate.

Of the 32 patients included, 23 received Naloxegol perioperatively and 9 did not. There was no statistically significant difference in baseline characteristics between groups, including age (71.2 vs 69.9 years, p = 0.88), BMI (28.4 vs 27.8, p = 0.74), or smoking status (p = 0.64). Return of bowel function was similar across both groups, with no significant differences observed in time to flatus (3.0 vs 2.3 days, p = 0.13), time to recommencement of solids (5.7 vs 5.2 days, p = 0.68), or time to first bowel motion (4.8 vs 4.0 days, p = 0.10). However, patients who received Naloxegol had a significantly longer length of stay compared to those who did not (14.5 vs 9.7 days, p = 0.02). There was no difference in complication rate (73% vs 56%, p=0.25).

In this retrospective cohort, perioperative Naloxegol use did not confer a measurable benefit in accelerating gastrointestinal recovery following open radical cystectomy. Despite similar baseline characteristics, Naloxegol was associated with a significantly longer hospital stay and showed no reduction in time to flatus, bowel motion, resumption of diet or complication rate. These findings question the routine use of Naloxegol in this setting and underscore the need for prospective studies to better define its role in enhanced recovery protocols.