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*Department of General Anesthesiology,
Transplant Center,
Department of Biostatistics & Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio
Address correspondence and reprint requests to Samuel A. Irefin, M.D., Department of General Anesthesiology / E31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. Address e-mail to irefins{at}ccf.org
After initiating a living donor liver transplant program at our institution, we observed that donor patients experienced significant postoperative pain despite the use of thoracic patient-controlled epidural analgesia (PCEA) infusion catheters. We retrospectively compared patients who underwent right lobe donor hepatectomy (RLDH, n = 15) with patients who had undergone major hepatic resection for tumor (MHRT, n = 15) to elucidate the cause for this observation. All patients had preoperative thoracic epidural catheters placed, and both groups had similar surgical exposure. Demographic information, intraoperative variables, intensity of postoperative pain by visual analog pain score (VAPS), side effects, total number of requested and delivered PCEA doses, and the total amount of bupivacaine (mg) and volume (mL) of PCEA solution administered through 48 h postoperatively were collected and analyzed. The RLDH group had a significantly longer surgical duration than did the MHRT group. The RLDH group patients had higher postoperative pain scores (P = 0.034), and were 2.76 (1.12–6.82, 95% CI) times more likely to have pain than those patients in the MHRT group. There was no significant difference between patient groups for the amount of bupivacaine and volume of PCEA solution administered. These observations may be explained, in part, by the longer duration of surgery in the RLDH group. The possible role of preemptive analgesia via PCEA infusion and better perioperative teaching of PCEA use are discussed; these may lead to improved early postoperative pain control in RLDH patients.
IMPLICATIONS: Patients who underwent right lobe donor hepatectomy (RLDH) experienced more postoperative pain as compared with patients after major hepatic resection for tumor. This may be partially explained by the longer surgical duration observed in the RLDH group. Better perioperative teaching for patient-controlled epidural analgesia use may improve early postoperative pain control in RLDH patients.
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  J.-D. Roy, L. Massicotte, M.-P. Sassine, R. F. Seal, and A. Roy A Comparison of Intrathecal Morphine/Fentanyl and Patient-Controlled Analgesia with Patient-Controlled Analgesia Alone for Analgesia After Liver Resection Anesth. Analg., October 1, 2006; 103(4): 990 - 994. [Abstract] [Full Text] [PDF]
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