Opioid Minimization After Liver Transplantation: Results of a Novel Pilot Study

Lee, Tiffany C.; Bittel, Lacey; Kaiser, Tiffany E.; Quillin, Ralph C.; Jones, Courtney; Shah, Shimul A.

doi:10.1002/lt.25829

Cited by 4 publications

(13 citation statements)

References 5 publications

(7 reference statements)

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“…In the single study that evaluated one preoperative dose of pregabalin, MME requirements were lower through 72 h post‐transplant 38 . Within the multimodal pain management protocols, pre and postoperative gabapentin in combination with scheduled APAP, opioid‐sparing anesthetics, “as needed” tramadol, and ketamine were all incorporated with the intention of minimizing opioid use 19,51,52 . Similar to the outcomes reported in kidney transplant studies, there was a universal reduction in MME per day and opioid prescribing at hospital discharge with the multimodal pain management protocols.…”

Section: Resultsmentioning

confidence: 80%

“…Eleven studies evaluated the impact of a single opioid‐sparing medication including pregabalin, continuous systemic lidocaine, and local anesthetics (single and continuous dosing) 18,37–46 . Furthermore, seven studies evaluated the impact of a multimodal analgesic strategies, and two assessed the impact of different education‐based interventions 19–21,47–52 …”

Section: Resultsmentioning

confidence: 99%

“…Efficacy outcomes were variable, but generally included evaluation of opioid use and PRPS. Each comparative study demonstrated a statistically significant reduction in opioid use for those who received the various minimization intervention(s) 18–21,37–42,47–52 . Patient‐reported pain scales were also evaluated, but the impact of opioid minimization interventions varied by study 19,37,41,42,50 .…”

Section: Resultsmentioning

confidence: 99%

“…Patient‐reported pain scales were also evaluated, but the impact of opioid minimization interventions varied by study 19,37,41,42,50 . When evaluating LOS and opioid prescribing at discharge, the impact of opioid minimization strategies also conferred variable results across the included studies but were not worse than control group analgesic regimens 18–21,37,47–52 . Safety outcomes were reported in 12 studies, which described either adverse drug effects related to the multimodal strategy employed or complications related to opioid use 18–21,37,40,41,44,49–52 .…”

Section: Resultsmentioning

confidence: 99%

“…Similar to the outcomes reported in kidney transplant studies, there was a universal reduction in MME per day and opioid prescribing at hospital discharge with the multimodal pain management protocols. One study also reported a shorter LOS and improved 36‐Item Short Form Health Survey (SF‐36) scores within the context of the opioid minimization protocol 52 . However, reduction in LOS was not universal.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

et al. 2023

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The opioid epidemic has impacted analgesia in the postoperative period for solid organ transplant (SOT) donors and recipients. However, optimal pain management and opioid stewardship strategies have not been identified across this unique population. The purpose of this systematic review was to evaluate the impact of perioperative opioid use and to describe multimodal analgesic strategies to reduce opiate use in SOT recipients and living donors. A systematic review was conducted. Electronic searches were performed in Medline, Embase, Google Scholar, and Web of Science through December 31, 2021. Title and abstracts were screened. Relevant articles underwent full-text review. Literature was separated into effects of opioid exposure on post-transplant outcomes, recipient pain management strategies, and living donor pain management strategies. Search yielded 25,190 records, and 63 were ultimately included. The impact of opioid use on post-transplant outcomes was assessed in 19publications. The risk of graft loss in pretransplant opioid users was assessed in six reports and was found to be higher in the majority (66%) of publications. Opioid minimization strategies were reported in 20 studies in transplant recipients. Twenty-four studies evaluated pain management strategies in living donors. Both populations used a combination of multimodal strategies to minimize opioid use throughout the hospitalization and on discharge. Opioids are associated with select negative outcomes in post-transplant recipients. To minimize their use while also maintaining appropriate analgesia, multimodal pain regimens should be considered in SOT recipients and donors.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%