Morphine Metabolism After Major Liver Surgery

Rudin, Åsa; Lundberg, Johan; Hammarlund‐Udenaes, Margareta; Flisberg, Per; Werner, Mads U.

doi:10.1213/01.ane.0000261847.26044.1d

Cited by 37 publications

(32 citation statements)

References 23 publications

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“…Patients after hepatic resection had higher plasma lidocaine concentrations compared with those after general surgery as early as 3 h postoperatively, and concentrations were continuing to rise at 5 h [9]. Altered morphine clearance and elevated plasma morphine concentrations were also shown in patients 2 days after hepatic resection [17]. Although morphine and local anaesthetic agents are metabolised by different pathways, the elevated plasma concentrations can be attributed to altered drug distribution or elimination after liver surgery secondary to changes in plasma protein, parenchymal injury and loss of functional liver parenchyma.…”

Section: Discussionmentioning

confidence: 92%

“…In addition, unexpected sensitivity to systemic opioid has been observed after hepatic resection, perhaps as a result of altered drug metabolism [16]. The plasma concentration of morphine and sedation score were higher in patients after liver resection compared with colonic resection, and this was correlated with the amount of liver resected [17]. Finally, co-analgesics with opioid-sparing effects.…”

Section: Discussionmentioning

confidence: 99%

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The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

Chan

Lai

Li³

et al. 2010

Anaesthesia

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SummaryThe analgesic efficacy of continuous local anaesthetic wound instillation after open hepatic surgery was evaluated. Forty-eight patients scheduled for elective liver surgery were assigned to receive either ropivacaine 0.25% or saline infusion at 4 ml.h)1 for 68 h via two multi-orifice indwelling catheters placed within the musculo-fascial layer before skin closure; plasma ropivacaine concentrations were measured during the infusion. Supplemental analgesia was provided by intravenous patient-controlled analgesia morphine. Patients in the ropivacaine group had decreased mean (SD) total morphine consumption (58 (30) mg vs 86 (44) mg, p = 0.01) and less pain at rest as well as after spirometry at 4, 12, 24, 48 and 72 h postoperatively (p < 0.01). Forced vital capacity was reduced postoperatively in both groups, but the reduction was greater in the saline group at 12 and 24 h (p = 0.03). The mean plasma concentration of ropivacaine increased to 2.05 (0.78) lg.ml )1 at the point when the infusion was terminated.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

Chan

Lai

Li³

et al. 2010

Anaesthesia

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“…The spinal morphine dose ranges from 100 to 500 micrograms useful guidance but may be a weight-related, set to 2 micrograms per kilo dose [47][48][49][50][51]. When an epidural or intrathecal technique is not possible, analgesia depend administration of intravenous morphine, either by the technique of PCA (Patient Controlled Analgesia) or regulated by the use of administrations, with bail according degree of pain present.…”

Section: Advantagesmentioning

confidence: 99%

Anesthesia in Liver Resections: Review

Bonofiglio

2017

JACCOA

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“…As the liver is an important organ for drug metabolism and detoxification it is important to realise potential risks of each modality in the context of liver parenchyma status, magnitude of resection, and concomitant liver or renal failure. Opiates have traditionally been the main stay of analgesia but can be associated with respiratory depression, excessive sedation, and exacerbation of hepatic encephalopathy [68] . As such patients on opiates require close observation in particular after major resections, HRS carried out in the presence of cirrhosis or renal impairment.…”

Section: Hepatic Failurementioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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Morphine Metabolism After Major Liver Surgery

Cited by 37 publications

References 23 publications

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery

Anesthesia in Liver Resections: Review

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

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