Surgically placed abdominal wall catheters on postoperative analgesia and outcomes after living liver donation

Abstract

Living donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for postoperative pain management, although it is often refused or contraindicated. Surgically placed abdominal wall catheters (AWCs) are a novel pain modality that can potentially provide pain relief for those patients who are unable to receive an epidural. A retrospective review was performed at a single center. Patients were categorized according to their postoperative pain modality: intravenous (IV) patient-controlled analgesia (PCA), AWCs with IV PCA, or patient-controlled epidural analgesia (PCEA). Pain scores, opioid consumption, and outcomes were compared for the first 3 postoperative days. Propensity score matches (PSMs) were performed to adjust for covariates and to confirm the primary analysis. The AWC group had significantly lower mean morphine-equivalent consumption on postoperative day 3 [18.1 mg, standard error (SE) 5 3.1 versus 28.2 mg, SE 5 3.0; P 5 0.02] and mean cumulative morphine-equivalent consumption (97.2 mg, SE 5 7.2 versus 121.0 mg, SE 5 9.1; P 5 0.04) in comparison with the IV PCA group; the difference in cumulative-morphine equivalent remained significant in the PSMs. AWC pain scores were higher than those in the PCEA group and were similar to the those in the IV PCA group. The AWC group had a lower incidence of pruritus and a shorter hospital stay in comparison with the PCEA group and had a lower incidence of sedation in comparison with both groups. Time to ambulation, nausea, and vomiting were comparable among all 3 groups. The PSMs confirmed all results except for a decrease in the length of stay in comparison with PCEA. AWCs may be an alternative to epidural analgesia after living donor liver resections. Randomized trials are needed to verify the benefits of AWCs, including the safety and adverse effects. Liver Transpl 21:478-486, 2015. V C 2015 AASLD.

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

“…The role of WI with local anesthetics to prevent postoperative pain after open liver surgery was evaluated in ten studies, which included a total of 1412 patients: five compared to TEA (2 RCTs, 2 POS, and 1 RO), four to placebo (RCTs), and one to systemic opioids (RCT) [24][25][26][27][28][29][30][48][49][50]. When compared to TEA, the use of WI produced conflicting evidence: two studies proved WI less effective in pain control than TEA while three studies proved no difference; of the three studies that reported data on LOS, one proved WI was associate with shorter LOS compared to TEA and two recorded no differences; no differences in surgical complication after WI or TEA were reported (Table 3) [24,25,[48][49][50].…”

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Combined with Oxycodone Infusion during Open Hepatectomy: A Randomized Controlled Trial

“…In recent decades, continuous or bolus infusions of opioids have been widely used in patient-controlled analgesia after liver resection. However, an increase in analgesic-related side effects, such as sedation, respiratory depression, pruritus, hallucinations and post-operative nausea and vomiting (PONV) has also been reported ( Aydogan et al, 2015 ; Khan et al, 2015 ; Allen et al, 2017 ). It is a challenge for anesthesiologists to perform a technique that could control sedation, analgesia, muscle relaxation, hemodynamic stability during the liver resection, and opioid-sparing analgesia after the surgery.…”

Acute Benefits After Liposomal Bupivacaine Abdominal Wall Blockade for Living Liver Donation: A Retrospective Review

“…Although epidural analgesia has historically been the standard of postoperative pain control, recent studies have found that postoperative coagulopathy may put patients at risk for neuraxial hematoma 1, 4. Accordingly, alternative analgesic methods that avoid this risk have been used in the search for safe but effective pain management 4, 5…”

“…Although single-injection transversus abdominis plane (TAP) blocks can provide excellent analgesia for major abdominal surgery, their primary shortcomings include limitations in dermatomal spread and short duration, with comprehensive analgesia rarely extending beyond 12 hours 6, 7. To extend analgesia duration, some investigators have placed TAP catheters to facilitate infusion of local anesthetic 4, 5. To date, however, this technique has been limited by high failure rates of secondary analgesia 8 …”