Better pain management protocols are needed for patients who undergo orthotopic liver transplantation, according to research presented here at the 2017 Annual Meeting of the Canadian Anesthesiologists Society (CAS).
“Liver transplantation is very painful surgery,” said Hussein Sadkhan, MD, London Health Sciences Center/Western University, London, Ontario. “We conducted a retrospective study to assess pain control in these patients. Our focus was the intensity of pain after surgery.”
The researchers reviewed 5-year data of liver transplant cases, including adult patients who had no history of chronic pain and were extubated within 48 hours after receiving a liver transplant.
The researchers looked at duration of intubation, preoperative pain score, pain medication needed, length of hospital stay, and pain score subsequent to extubation during admission to the intensive care unit and multi-organ transplant unit. They also reviewed modalities of pain management, type of opioid analgesics, route of administration, and opioid-related side effects.
An initial 300 patients were identified, and 200 were included in the analysis. Nearly three quarters of patients (72%) were male. Their mean age was 53 years and their mean weight was 78 kg. Mean length of stay was 14.86 days.
Mean visual analogue scores were 3.40 on day 1, 4.99 on day 2, and 4.75 on day 3. A total of 178 (89%) patients received intermittent boluses for pain, 4.5% of patients received a continuous infusion of opioids, and 6.5% received patient-controlled analgesia.
Of the patients, 130 received hydromorphone, 63 received fentanyl, and 7 received morphine.
There were no reports of serious side effects such as respiratory depression or severe sedation related to the analgesic medications that were administered.
“These patients experience moderate pain after this surgery,” said Dr. Sadkhan. “We should do better to improve our management of these patients. We think patient-controlled analgesia should be an option for more of these patients.”
[Presentation title: Post-Operative Pain Management of Orthotopic Liver Transplantation (OLT): Retrospective Study. Abstract 282512]