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Pain management in living related adult donor hepatectomy: feasibility of an evidence-based protocol in 100 consecutive donors.

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Dewe, Guillaume [UCL] Steyaert, Arnaud [UCL] De Kock, Marc Lois, Fernande Reding, Raymond [UCL] Forget, Patrice

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. 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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "BMC Research Notes" - Vol. 11, no.1, p. 834 (2018)
Peer reviewed yes
Publisher BioMed Central Ltd. (London, England)
issn 1756-0500
e-issn 1756-0500
Publication status Publié
Affiliations UCL - SSS/IREC - Institut de recherche expérimentale et clinique
UCL - (SLuc) Service d'anesthésiologie
UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - (SLuc) Service de chirurgie et transplantation abdominale
Keywords Living related adult donor hepatectomy ; Pain management
Links
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Bibliographic reference Dewe, Guillaume ; Steyaert, Arnaud ; De Kock, Marc ; Lois, Fernande ; Reding, Raymond ; et. al. Pain management in living related adult donor hepatectomy: feasibility of an evidence-based protocol in 100 consecutive donors.. In: BMC Research Notes, Vol. 11, no.1, p. 834 (2018)
Permanent URL http://hdl.handle.net/2078.1/208093