Transitional Study of Patient-Controlled Analgesia Morphine With Ketorolac to Patient-Controlled Analgesia Morphine With Parecoxib Among Donors in Adult Living Donor Liver Transplantation: A Single-Center Experience

Lim, Kun-Eng; Liu, C.-K.; Chen, C.-L.; Wang, C.-H.; Huang, Chun-Chieh; Cheng, K.-W.; Wu, Shao-Chun; Shih, Tsung-Hsiao; Yang, Shang-Ju; Lee, Y.-E.; Jawan, Bruno; Juang, Sin-Ei

doi:10.1016/j.transproceed.2015.11.021

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…These studies also suggest that NSAID use is possibly associated with a more preserved immune function (by increasing CD3+ and NK cell levels), reduced systemic inflammatory response (decreased levels of IL-4 and increased TGF-β), associated with a longer tumor-free interval and disease-free survival time (Table 3) [40,45]. The use of parecoxib or ketorolac leads to similar results in terms of postoperative pain control (Table 3) [55].…”

Section: Trials Assessing Nsaidsmentioning

confidence: 85%

“…The role of NSAIDs in preventing postoperative pain after open liver surgery was evaluated in three studies, which included a total of 186 patients: two compared to placebo (RCTs) and one compared parecoxib to ketorolac (RO) [40,45,55]. When compared to the placebo, the use of NSAIDs proved to be more effective in pain control and associated with a higher opioid-sparing effect.…”

Section: Trials Assessing Nsaidsmentioning

confidence: 99%

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

Dudek

Zawadka

Andruszkiewicz

et al. 2021

JCM

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Background: The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery. Methods: The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors’ agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design. Results: The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review. Conclusions: The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a “blended approach” which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative “stress hormones”, and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.

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Section: Trials Assessing Nsaidsmentioning

confidence: 85%

Section: Trials Assessing Nsaidsmentioning

confidence: 99%

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

Dudek

Zawadka

Andruszkiewicz

et al. 2021

JCM

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“…36 In addition, combination ketorolac with IV-PCA mixture was reported to shorten the postoperative recovery period in patients with colorectal surgery. 37 The same goes for the included studies of our meta-analysis, ketorolac was mixed to the IV-PCA for the purpose of enhancing the analgesic effects provided by opioids while decreasing their side reactions. 17,[20][21][22] Finally, a frequent problem is that mixing 2 or more injections together in infusion solutions induced physical changes and chemical degration of ingredients could cause precipitation or crystallization, thus the efficacy was discounted.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efﬁcacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

Chen

Lei

et al. 2019

Preprint

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Backgroud Patient-controlled analgesia(PCA) with intravenous an opioid has been suggested as a effective method of postoperative pain relief. There are several randomized controlled trials (RCTs) of comparison of oxycodone and fentanyl for IV-PCA in surgical patients. The purpose of this study was to performed a meta-analysis to compare the effect of intravenous oxycodone and fentanyl on post-operative pain in sugical patients from collected current data. Methods The RCTs of oxycodone versus fentanyl for IV-PCA were gathered from PubMed, Embase, Cochrane library, CNKI and VIP data. After data extraction and quality assessment of the included RCTs, the RevMan 5.3 software was applied for meta-analysis of numerical rating scale (NRS) scores, accumulated IV-PCA consumption of oxycodone and fentanyl, patient satisfaction, postoperative nausea and vomiting (PONV), and other adverse events (AEs). Results Results reported from eight RCTs involving 600 patients are included in the meta-analysis. The NRS score at rest and upon movement of group oxycodone was signiﬁcantly lower than that of group fentanyl (WMD= -3.85, 95% CI -4.93~-2.76, P<0.00001; WMD= -4.31, 95% CI -5.79~-2.84, P<0.00001); however, the incidence of PONV and dizziness was signiﬁcantly higher in group oxycodone than in group fentanyl (OR = 2.41, 95% CI 1.60~3.63, P < 0.0001; OR=3.69, 95% CI 2.17~6.26, P<0.00001). Accumulated IV-PCA consumption in group oxycodone was less than in group fentanyl overall the 48 hours postoperatively (WMD= -12.11, 95% CI -18.42~-5.80, P = 0.0002). There was no significant difference in patient satisfaction between oxycodone and fentanyl (OR=0.73, 95% CI 0.11~5.04, P= 0.75). Conclusion According to the evidence, this meta-analysis suggest that oxycodone IV-PCA is superior to fentanyl in postoperative pain relief, whereas the higher incidence of PONV and dizziness was accompanied with oxycodone. Further large-scale and well-designed studies are needed to summarize and analyse the data to draw a more convincing conclusion.

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“…Alternatives to TEA in the form of continuous IV bupivacaine 0.25% through catheter in rectus sheath, subcostal TAP blocks, and right thoracic paravertebral block along with IV opioids have been investigated as a part of a multimodal analgesic regimen. To supplement IV analgesia, drugs like ketorolac, dexmedetomidine, gabapentin, and parecoxib have been studied for an opioid‐sparing effect. However, there are no systematic reviews to establish their safety and efficacy in liver donors.…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural analgesia in donor hepatectomy: An analysis

et al. 2018

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The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214-221 2018 AASLD.

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Transitional Study of Patient-Controlled Analgesia Morphine With Ketorolac to Patient-Controlled Analgesia Morphine With Parecoxib Among Donors in Adult Living Donor Liver Transplantation: A Single-Center Experience

Cited by 7 publications

References 14 publications

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

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

Comparison of efﬁcacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

Thoracic epidural analgesia in donor hepatectomy: An analysis

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