Opioid Avoidance After Liver Transplantation: The Ever‐Shifting Pain Management Paradigm

Abstract

Alternatively viewed as a panacea and a scourge, prescription opioids are now widely recognized to cause substantial morbidity and mortality. (1) The multifactorial contributions to the current opioid-related public health crisis, including the campaign to make pain the fifth vital sign and the expectation, fueled by pharmaceutical company marketing campaigns, that pain should be treated with a pill, have resulted in thousands of preventable overdoses and deaths. (1) In recognition of the dire consequences of opioid overprescribing, opioid safety initiatives and programs aim to decrease opioid-related morbidity and mortality.Despite widespread attempts to curtail opioid use and misuse, opioid prescribing to patients with cirrhosis remains high for several interconnected reasons. First, up to 80% of patients with cirrhosis have chronic pain, and there is a paucity of safe, opioid-sparing alternative analgesics (eg, nonsteroidal anti-inflammatories) for patients with cirrhosis. (2,3) Furthermore, multimodal, nonpharmacological approaches to pain management have been slow to percolate into cirrhosis care. (3) Finally, historical overprescription of opioids to patients with cirrhosis (eg, up to half of patients per year) has created

Pain management for liver transplant recipients

“…Postoperative opioid requirements have been found to be the highest in the first 24 h following transplantation and decrease by 50% in the subsequent 72 h [7]. However, early postoperative opioid use can also initiate opioid-induced hyperalgesia, induce postoperative delirium, trigger gut ileus, and prolong overall hospitalization [9]. Additionally, early postoperative opioid use may be associated with an increased risk of allograft loss and mortality [10].…”