The Relationship between Postoperative Intravenous Patient-Controlled Fentanyl Analgesic Requirements and Severity of Liver Disease

• Published in: Transplantation proceedings Vol. 44; no. 2; pp. 445 - 447
• Main Authors: Ko, J.S, Shin, Y.H, Gwak, M.S, Jang, C.H, Kim, G.S, Lee, S.-K
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.03.2012; Elsevier
• Subjects: Analgesia, Patient-Controlled; Analgesics, Opioid - administration & dosage; Biological and medical sciences; Chi-Square Distribution; Cough - complications; Female; Fentanyl - administration & dosage; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Health Status Indicators; Humans; Infusions, Intravenous; Liver Diseases - diagnosis; Liver Diseases - surgery; Liver Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Predictive Value of Tests; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Republic of Korea; Human; Postoperative; Agonist; Intravenous administration; μ Opioid receptor; Fentanyl; Opiates; Patient; Hepatic disease; Transplantation; Narcotic analgesic; Medicine; Requirement; Treatment; Surgery; Digestive diseases; Graft; Phenylpiperidine derivatives
• DOI: 10.1016/j.transproceed.2012.01.017
• ISSN: 0041-1345

Abstract Purpose Decreased inhalational anesthetic requirements during orthotopic liver transplantation (OLT) have been reported according to the severity of the pre-existent disease as well as decreased opioid requirements thereafter. The aim of the present study was to determine the relationship between postoperative opioid requirements and severity of liver disease among OLT patients. Methods We retrospectively reviewed 44 recipients who used intravenous fentanyl-based patient-controlled analgesia (PCA) after OLT from November 2009 to May 2010. The severity of liver disease was assessed using the model for end-stage liver disease (MELD) score. Recipients were divided into a low-MELD group (<20; n = 30) and a high-MELD group (≥20; n = 14). The amounts of PCA infusion and rescue opioid up to 3 postoperative days (POD) were compared between the 2 groups. The intensity of pain at rest and when coughing was assessed using visual analog scale (VAS) scores. Results The cumulative opioid requirements via PCA on POD 1, 2, and 3 were significantly lower in the high-MELD than the low-MELD group. The amounts of rescue opioid were similar between the 2 groups. However, the intensity of pain at both rest and when coughing on POD 1, 2, and 3 were significantly less severe in the high-MELD than the low-MELD group. Conclusions OLT patients with high MELD scores required less postoperative opioids and experienced less pain than those with low scores. Therefore, postoperative pain control after OLT should be carefully titrated according to the severity of the liver disease.