Multimodal Pain Management of Liver Transplantation: What Is New?

Abstract

Liver transplantation (LT) is a life-saving treatment representing the only viable option for patients suffering from end-stage liver disease (ESLD) or acute liver failure. Patients who undergo LT require a multidisciplinary approach to postoperative pain management. However, pain management in this context is often inadequately explored. Limited options exist for proper pain control in patients with hepatic failure, mainly due to the increased risk of kidney and multi-organ failure. In LT candidates, specific analgesics may elevate the risk of side effects, such as hepatic encephalopathy, acute renal failure, and gastrointestinal bleeding, consequently increasing overall morbidity and mortality. In the case of LT, the post-operative pain might be underestimated since the demand for analgesics is typically lower than other major abdominal surgeries. Consequently, there is a lack of studies addressing post-operative pain management. This review aims to outline current strategies for pain management in LT, with a particular focus on opioid-free approaches, and to introduce forthcoming developments in this field.