Pain management in living related adult donor hepatectomy

feasibility of an evidence-based protocol in 100 consecutive donors

Guillaume Dewe, Arnaud Steyaert, Marc De Kock, Fernande Lois, Raymond Reding, Patrice Forget (Corresponding Author)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: Living donor hepatectomy (LDH) has important consequences in terms of acute and chronic pain. We proposed an anesthetic protocol based on the best currently available evidence. We report the results of this protocol's application. RESULTS: We performed a retrospective descriptive study of 100 consecutive donors undergoing LDH. The protocol included standardized information provided by the anesthetist, pharmacological anxiolysis and preventive analgesia. Specifically, pregabalin premedication (opioid-free) intravenous anesthesia (with clonidine, ketamine, magnesium sulphate and ketorolac) and epidural analgesia were proposed. Postoperative follow-up was conducted by the Postoperative Pain Service. This analysis included 100 patients (53 women, 47 men, median age 32.7 years old [28.4-37.3]), operated by xypho-umbilical laparotomy. All elements of our anesthetic protocol were applied in over 75% of patients, except for the preoperative consultation with a senior anesthesiologist (55%). The median number of applied item was 7 [interquartile range, IQR 5-7]. Median postoperative pain scores were, at rest and at mobilization respectively 3 [IQR 2-4] and 6 [IQR 4.5-7] on day 1; 2 [IQR 1-3] and 5 [IQR 3-6] on day 2; and 2 [IQR 0-3] and 4 [IQR 3-5] on day 3. In conclusion, LDH leads to severe acute pain. Despite the proposal of a multimodal evidence-based protocol, its applicancy was not uniform and the pain scores remained relatively high.
Original languageEnglish
Article number834
JournalBMC Research Notes
Volume11
DOIs
Publication statusPublished - 26 Nov 2018

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Living Donors
Hepatectomy
Pain Management
Anesthetics
Acute Pain
Tissue Donors
Postoperative Pain
Ketorolac
Magnesium Sulfate
Ketamine
Clonidine
Opioid Analgesics
Umbilicus
Intravenous Anesthesia
Epidural Analgesia
Premedication
Chronic Pain
Analgesia
Laparotomy
Referral and Consultation

Keywords

  • Living related adult donor hepatectomy
  • Pain management

Cite this

Pain management in living related adult donor hepatectomy : feasibility of an evidence-based protocol in 100 consecutive donors. / Dewe, Guillaume; Steyaert, Arnaud; De Kock, Marc; Lois, Fernande; Reding, Raymond; Forget, Patrice (Corresponding Author).

In: BMC Research Notes, Vol. 11, 834, 26.11.2018.

Research output: Contribution to journalArticle

Dewe, Guillaume ; Steyaert, Arnaud ; De Kock, Marc ; Lois, Fernande ; Reding, Raymond ; Forget, Patrice. / Pain management in living related adult donor hepatectomy : feasibility of an evidence-based protocol in 100 consecutive donors. In: BMC Research Notes. 2018 ; Vol. 11.
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abstract = "OBJECTIVE: Living donor hepatectomy (LDH) has important consequences in terms of acute and chronic pain. We proposed an anesthetic protocol based on the best currently available evidence. We report the results of this protocol's application. RESULTS: We performed a retrospective descriptive study of 100 consecutive donors undergoing LDH. The protocol included standardized information provided by the anesthetist, pharmacological anxiolysis and preventive analgesia. Specifically, pregabalin premedication (opioid-free) intravenous anesthesia (with clonidine, ketamine, magnesium sulphate and ketorolac) and epidural analgesia were proposed. Postoperative follow-up was conducted by the Postoperative Pain Service. This analysis included 100 patients (53 women, 47 men, median age 32.7 years old [28.4-37.3]), operated by xypho-umbilical laparotomy. All elements of our anesthetic protocol were applied in over 75{\%} of patients, except for the preoperative consultation with a senior anesthesiologist (55{\%}). The median number of applied item was 7 [interquartile range, IQR 5-7]. Median postoperative pain scores were, at rest and at mobilization respectively 3 [IQR 2-4] and 6 [IQR 4.5-7] on day 1; 2 [IQR 1-3] and 5 [IQR 3-6] on day 2; and 2 [IQR 0-3] and 4 [IQR 3-5] on day 3. In conclusion, LDH leads to severe acute pain. Despite the proposal of a multimodal evidence-based protocol, its applicancy was not uniform and the pain scores remained relatively high.",
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