Optimal management of perioperative analgesia regarding immediate and short‐term outcomes after liver transplantation – A systematic review, meta‐analysis and expert panel recommendations

Sun, Li-Ying; Gitman, Marina; Malik, Ashish; Terry, Pan Ling Te; Spiro, Michael; Raptis, Dimitri Aristotle; Ramsay, Michael A. E.

doi:10.1111/ctr.14640

Cited by 10 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This shift underscores the importance of optimizing postoperative pain management. Such early recovery efforts align with the principles outlined in Enhanced Recovery After Surgery (ERAS) protocols, which have demonstrated potential benefits in improving postoperative outcomes [2]. Table 1 summarizes factors that may influence the analgesic requirements of patients affected by end-stage liver disease (ESLD) undergoing LT [2,8].…”

Section: Resultsmentioning

confidence: 94%

“…Ensuring adequate pain control is crucial as it enhances patient comfort and facilitates early mobilization, ultimately contributing to a more rapid overall recovery. Also, respiratory independence is paramount for LT patients, as delayed weaning from mechanical ventilation can adversely impact outcomes [2]. The subcostal incision required for accessing the surgical site can lead to discomfort, especially during activities like deep breathing, coughing, and mobilization.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal Pain Management of Liver Transplantation: What Is New?

Castellani Nicolini,

Belfiore,

Biancofiore

2023

OBM Transplant

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Multimodal Pain Management of Liver Transplantation: What Is New?

Castellani Nicolini,

Belfiore,

Biancofiore

2023

OBM Transplant

View full text Add to dashboard Cite

show abstract

“…Another systematic review by Sun et al , this time focusing on deceased donor liver transplant recipients, reviewed nine studies that aimed to provide recommendations on optimal perioperative analgesia management for liver transplant patients [21 ▪▪ ]. The review compared two groups, an opioid cohort and opioid-avoidance cohort, and included interventions such as TEA, TAP block, AWC, hand massage, and multimodal drug regimens.…”

Section: Multimodal Pain Managementmentioning

confidence: 99%

Pain management for liver transplant recipients

Kaur,

Henthorn,

Hendrickse

2023

Current Opinion in Organ Transplantation

View full text Add to dashboard Cite

Purpose of review Liver transplant recipients pose several pain management challenges. Altered hepatic drug metabolism and clearance in end-stage liver disease patients complicates the use of certain medications, while existing coagulopathy and thrombocytopenia can limit the use of regional anesthetic techniques. Largely due to a high prevalence of substance use disorders, these patients have increased vulnerability to opioid misuse in the perioperative period, which can make acute postoperative pain difficult to control and potentiates prolonged and painful recovery, increasing the risk of developing chronic postsurgical pain. We present current evidence-based literature that reviews optimal pain management strategies for this challenging patient demographic. Recent findings Multiple studies have shown that thoracic epidurals provide superior pain control in open hepatic resections. Recent data suggests thoracic epidurals may be safely considered in select liver transplant recipients with normal preoperative coagulation status; however, this evidence is limited, and further studies are needed. When the risks of coagulopathy prohibit epidural placement, truncal blocks such as transversus abdominis plane blocks or quadratus lumborum blocks and abdominal wound catheters can serve as alternative regional modalities. Specialized teams should manage pain using a multimodal approach. Summary Thoracic epidural analgesia may be an option for liver transplant recipients with normal coagulation profiles prior to surgery; however, additional studies are warranted. Other regional techniques are also available. Emphasis should be placed on optimizing multimodal pain medication management. Nonpharmacological interventions should also be considered.

show abstract

“…[58][59][60] It is strongly suggested that patients with SFSG should be monitored in an ICU environment with regular assessment. Opioid sparing multimodal analgesia should be strongly considered in these patients as part of an ERAS pathway as they have shown to improve short-term outcomes after LT. 61…”

Section: Postoperative Monitoring and Intervention Enhanced Recovery ...mentioning

confidence: 99%

Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Chadha,

Sakai,

Rajakumar

et al. 2023

Transplantation

Self Cite

View full text Add to dashboard Cite

Background. During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS). Methods. A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India. Results. It was determined that centers with experience in living donor liver transplantation should utilize potential small for size grafts. Higher risk recipients with sarcopenia, cardiopulmonary, and renal dysfunction should receive small for size grafts with caution. In the intraoperative phase, a restrictive fluid strategy should be considered along with routine use of cardiac output monitoring, as well as use of pharmacologic portal flow modulation when appropriate. Postoperatively, these patients can be considered for enhanced recovery and should receive proactive monitoring for SFSS, nutrition optimization, infection prevention, and consideration for early renal replacement therapy for avoidance of graft congestion. Conclusions. Our recommendations provide a framework for the optimal anesthetic and critical care management in the perioperative period for patients with grafts that put them at risk of developing SFSS. There is a significant limitation in the level of evidence for most recommendations. This statement aims to provide guidance for future research in the perioperative management of SFSS.

show abstract

Optimal management of perioperative analgesia regarding immediate and short‐term outcomes after liver transplantation – A systematic review, meta‐analysis and expert panel recommendations

Cited by 10 publications

References 20 publications

Multimodal Pain Management of Liver Transplantation: What Is New?

Multimodal Pain Management of Liver Transplantation: What Is New?

Pain management for liver transplant recipients

Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Contact Info

Product

Resources

About