Pain Control After Liver Transplantation Surgery

Feltracco, Paolo; Carollo, Cristiana; Barbieri, Stefania; Milevoj, M.; Pettenuzzo, Tommaso; Gringeri, Enrico; Boetto, Riccardo; Ori, Carlo

doi:10.1016/j.transproceed.2014.07.023

Cited by 28 publications

(24 citation statements)

References 37 publications

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“…As such, this protective mechanism against hepatotoxic N ‐acetyl‐ p ‐benzoquinone synthesis is not attenuated in patients with liver disease using acetaminophen at recommended doses . Single doses up to 1 g and daily doses up to 3 g/day can be used for analgesia in patients recovering from liver transplantation and offer a safer alternative than nonsteroidal antiinflammatory drugs that can greatly increase the risk of nephrotoxicity if given in combination with calcineurin inhibitors . The regimen used in our study appeared to be well tolerated.…”

Section: Discussionmentioning

confidence: 78%

“…This population is particularly susceptible to postsurgical opioid misuse given the connection between substance use disorder and this outcome . Additionally, liver transplant candidates with severely compromised hepatic function are predisposed to opioid‐related adverse effects such as dizziness, nausea, and, most dangerous, respiratory depression . This increased susceptibility to adverse effects persists even after liver transplantation .…”

mentioning

confidence: 99%

“…2,3 Additionally, liver transplant candidates with severely compromised hepatic function are predisposed to opioid-related adverse effects such as dizziness, nausea, and, most dangerous, respiratory depression. 4 This increased susceptibility to adverse effects persists even after liver transplantation. 4 The difficulty using opioids to reduce pain in this population has repercussions beyond patient comfort; for example, the use of opioids is associated with poor allograft and survival outcomes.…”

mentioning

confidence: 99%

“…4 This increased susceptibility to adverse effects persists even after liver transplantation. 4 The difficulty using opioids to reduce pain in this population has repercussions beyond patient comfort; for example, the use of opioids is associated with poor allograft and survival outcomes. 5,6 Despite the growing body of evidence demonstrating the risks associated with opioids after transplantation, they remain a mainstay of therapy in this patient population.…”

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confidence: 99%

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Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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Study Objective Nonopioid strategies to optimize pain management in patients after liver transplantation remain underexplored. The purpose of this study was to evaluate whether the use of a multimodal pain management (MPM) order set would reduce postoperative opioid use in adult patients after liver transplantation. Design Retrospective pre– and post–order set implementation study. Setting Large academic tertiary care hospital. Patients Thirty‐one adults who underwent liver transplantation were included; of these, 18 received provider‐managed pain regimens (pre‐MPM group: August 20, 2016–January 17, 2018), and 13 received the MPM order set (post‐MPM group: January 18–July 31, 2018) after implementation of the order set on January 18, 2018. Measurements and Main Results The MPM order set included standardized receipt of acetaminophen 650 mg every 6 hours, gabapentin 300 mg every 8 hours (adjusted for renal function), and opioids for breakthrough pain. Patients managed with the MPM order set received, on average, 30.6 fewer opioid morphine milligram equivalents per day after final extubation than patients who did not receive MPM (median 16, interquartile range [IQR] 4.5–45.6 vs median 46.6, IQR 30.1–75.2; Mann‐Whitney U test, p=0.031). Although patients in the post‐MPM group had significantly worse renal function at baseline, no other statistically significant differences in baseline characteristics, pain scores, or prescribed outpatient opioids were noted between groups. Patients in the pre‐MPM group had a shorter intensive care unit and overall length of stay; however, patients in the post‐MPM group may have had more complex postoperative courses contributing to these differences. Conclusion Implementation of the MPM order set significantly reduced postoperative opioid use in liver transplant recipients. Our results provide a compelling rationale to further investigate the use of a non–opioid‐centered strategy to optimize pain management in patients recovering from liver transplantation, a population vulnerable to the risks of opioid use such as opioid use disorder, increased susceptibility to adverse effects, and poor allograft and survival outcomes.

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Section: Discussionmentioning

confidence: 78%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

et al. 2019

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“…1 The shortage of donor organs continues to be the rate-limiting factor for liver transplant throughout the world. 2 Hepatocyte transplant is a promising alternative to orthotopic liver transplant to treat chronic liver diseases 3 and can also be used as a "bridge" to liver transplant in cases of liver failure.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Baz

Demerdash²,

Kamel³

et al. 2018

Exp Clin Transplant

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Objectives: Liver transplant is the cornerstone line of treatment for chronic liver diseases; however, the long list of complications and obstacles stand against this operation. Searching for new modalities for treatment of chronic liver illness is a must. In the present research, we aimed to compare the effects of transplant of undifferentiated human mesenchymal stem cells, in vitro differentiated mesenchymal stem cells, and adult hepatocytes in an experimental model of chronic liver failure. Materials and Methods: Undifferentiated human cord blood mesenchymal stem cells were isolated, propagated, and characterized by morphology, gene expression analysis, and flow cytometry of surface markers and in vitro differentiated into hepatocytelike cells. Rat hepatocytes were isolated by double perfusion technique. An animal model of chronic liver failure was developed, and undifferentiated human cord blood mesenchymal stem cells, in vitro hepatogenically differentiated mesenchymal stem cells, or freshly isolated rat hepatocytes were transplanted into a CCL4 cirrhotic experimental model. Animals were killed 3 months after transplant, and liver functions and histopathology were assessed. Results: Compared with the cirrhotic control group, the 3 cell-treated groups showed improved alanine aminotransferase, aspartate aminotransferase, albumin, and bilirubin levels, with best results shown in the hepatocyte-treated group. Histopathologic examination of the treated groups showed improved fibrosis, with best results obtained in the undif ferentiated mesenchymal stem cell-treated group. Conclusions: Both adult hepatocytes and cord blood mesenchymal stem cells proved to be promising candidates for cell-based therapy in liver regeneration on an experimental level. Improved liver function was evident in the hepatocyte-treated group, and fibrosis control was more evident in the undifferentiated mesenchymal stem cell-treated group.

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Lebertransplantation

Grundmann¹,

Debus²

2021

Evidenzbasiertes Perioperatives Management in Der Viszeralchirurgie

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Pain Control After Liver Transplantation Surgery

Cited by 28 publications

References 37 publications

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

Implementation of a Multimodal Pain Management Order Set Reduces Perioperative Opioid Use after Liver Transplantation

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Lebertransplantation

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