Does multimodal perioperative pain management enhance immediate and short-term outcomes after living donor partial hepatectomy? - A systematic review of the literature and expert panel recommendations

Brian J Hogan*, Sher-Lu Pai, Raymond Planinsic, Kyung-Suk Suh, Jens G Hillingso, Shahi Abdul Ghani, Ka Siu Fan, Michael Spiro, Dimitri Aristotle Raptis, Vijay Vohra, Georg Auzinger, ERAS4OLT.org Working Group

*Corresponding author for this work
    3 Citations (Scopus)

    Abstract

    BACKGROUND: The optimal analgesic strategy for patients undergoing donor hepatectomy is not known and the potential short- and long-term physical and psychological consequences of complications are significant.

    OBJECTIVES: To identify whether a multimodal approach to pain of the donor intraoperatively enhances immediate and short-term outcomes after living liver donation, and to provide international expert panel recommendations.

    DATA SOURCES: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.

    METHODS: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. PROSPERO 2021 CRD42021260699.

    RESULTS: Nine studies assessing multi-modal analgesia strategies were included in a qualitative assessment. Interventions included local, regional, and neuro-axial anesthetic techniques, pharmacological intervention (NSAIDs, COX-2 inhibitors, ketamine, dexmedetomidine, and lidocaine), and acupuncture. Overall, there was a significant (40%) reduction in opioid requirement on day 1 and a significant reduction in pain scores in the intervention vs control groups. Significant reductions in either length of stay or post-operative complications were demonstrated in four of nine studies.

    CONCLUSIONS: Opioid use for patients undergoing donor hepatectomy is likely to impact both their short- and long-term outcomes. To reduce post-operative pain scores, shorten length of hospital stay, and promote earlier post-operative return of bowel function, we recommend that multi-modal analgesia be offered to patients undergoing living donor hepatectomy. Further research is required to confirm which multi-modal techniques are most associated with enhanced recovery in living liver donors.

    Original languageEnglish
    Article numbere14649
    JournalClinical Transplantation
    Volume36
    Issue number10
    Number of pages10
    ISSN0902-0063
    DOIs
    Publication statusPublished - Oct 2022

    Keywords

    • Analgesics, Opioid/therapeutic use
    • Hepatectomy
    • Humans
    • Lidocaine/adverse effects
    • Liver
    • Pain Management/adverse effects
    • Pain, Postoperative/chemically induced
    • enhanced recovery after surgery
    • pain
    • analgesia
    • living donor liver transplant

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