Pain
Richard Fagbemigun, MD, MSc
Resident Physician(PGY-2)
Johns Hopkins Hospital
Baltimore, Maryland, United States
Rafaello Ibrado, MD
Resident Physician
University of Florida
Oak Lawn, Illinois, United States
Puneet Gupta, MD
Resident Physician
George Washington University Hospital
Washington, District of Columbia, United States
Richard Fagbemigun, MSc
George Washington University School of Medicine & Health Sciences
Washington, District of Columbia, United States
Liver transplant recipients have complex perioperative pain management needs due to altered
pharmacokinetics and comorbidities. Opioid-based pain control poses risks such as dependency, adverse effects, and potential impact on graft survival. Alternative pain management strategies, including regional anesthesia and multimodal analgesia, are being explored.
Design:
Review of existing literature on opioid-reducing pain management strategies in liver transplant recipients. Comparison of regional anesthesia techniques: thoracic epidural analgesia (TEA), transversus abdominis plane (TAP) block, and erector spinae plane (ESP) block. Analysis of alternative pain management approaches, including non-opioid medications and adjunct therapies (e.g., pregabalin, lidocaine infusion, massage therapy).
Results:
For regional anesthesia, TEA offers effective pain control but presents concerns over coagulopathy risks. TAP blocks have been found to reduce opioid consumption without significantly altering pain scores. Meanwhile, the Erector Spinae Plane (ESP) Block is emerging as a safe alternative, though it necessitates further study for validation. For non-conventional pain management, preoperative pregabalin reduced opioid consumption by nearly 70%. Lidocaine infusions show promise but require additional validation. Adjunct therapies (hand/back massage) demonstrated reductions in pain and anxiety.
Conclusions:
Effective pain control is essential for recovery, reducing hospital stay, and preventing complications. Multimodal, opioid-reducing strategies improve patient outcomes and reduce opioid-related risks. Further large-scale, randomized trials are needed to determine the most effective pain management protocols.
