Anesthésie et recherche clinique
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Post-operative Pain Management of Orthotopic Liver Transplantation: Retrospective Study

Qutaiba A Tawfic, Hussein Sadkhan, Shaqayeq Marashi, Stephen Morrison, Kamal Kumar, Kevin Armstrong, Karim Qumosani and Achal Dhir

Introduction: Orthotopic liver transplantation (OLT) is one of the most extensive of all abdominal surgeries. The
main focus of perioperative management for these patients has been to reduce mortality and morbidity, with little
attention to postoperative pain management. This has resulted in a paucity of data on pain and its management in
OLT.
Method: This is a descriptive, retrospective study of OLT recipients at the London Health Sciences Centre,
Western University, over five years (January 2011-December 2016). In addition to demographic information, we
collected data regarding pain management modalities, specific opioid analgesics, route of administration and opioidrelated
serious side effects.
Results: Data for 200 patients were included in this analysis. The mean visual analogue scores were: day one:
3.40 ± 1.71, day two: 4.99 ± 0.11 and day three: 4.75 ± 0.12. During their stay in the intensive care unit (ICU), 178
patients received intermittent boluses of an opioid (89%), nine patients received a continuous infusion of opioid
(4.5%) and 13 patients received patient-controlled analgesia (PCA) (6.5%). There was no significant difference in
mean pain scores between the three groups on day 1 (P=0.234). There was no respiratory depression/arrest
observed related to opioid usage.
Discussion: This study demonstrates that OLT patients experience moderate pain during the first three days
following extubation. The data obtained from this investigation will help to formulate a better understanding of post
OLT pain and optimize a pain management protocol that is both efficient and effective.