Adult Live Donor Hepatectomy: A Retrospective Pilot Study Comparing Four Strategies of Perioperative Pain Control
- *Corresponding Author:
- David M. Rosenfeld, MD
Department of Anesthesiology
Mayo Clinic Arizona, 5777 E. Mayo Blvd, USA
E-mail: [email protected]
Received Date: February 17, 2012; Accepted Date: March 19, 2012; Published Date: March 24, 2012
Citation: Rosenfeld DM, Trentman TL, Simula DV, Ivancic MG, Poterack KA, et al. (2012) Adult Live Donor Hepatectomy: A Retrospective Pilot Study Comparing Four Strategies of Perioperative Pain Control. J Transplant Technol Res S1: 007. doi: 10.4172/2161-0991.S1-007
Copyright: © 2012 Rosenfeld DM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Purpose: To compare the post operative pain control of four distinct management strategies in adult live donor hepatectomy.
Methods: Sixty-two ASA physical status I and II patients undergoing live donor hepatic resection from 2001 to 2008 were retrospectively organized into four groups for post-operative pain control. Group A received epidural catheter, Group B received PCA, Group C received intraoperative dexmedetomidine and PCA, and Group D received perioperative gabapentin, intraoperative dexmedetomidine, and PCA. Four day postoperative visual analog pain scores (VAS), intravenous morphine equivalent use, duration of hospitalization, and time until return of bowel function was measured.
Results: Mean visual analog pain score for a cumulative four day postoperative interval demonstrated 2.2 (± 0.73) for epidural catheter, 3.4 (± 1.13) for patient controlled analgesia (PCA), 3.0 (± 1.42) for intraoperative dexmedetomidine infusion plus PCA, and 2.3 (± 1.09) for perioperative gabapentin, intraoperative dexmedetomidine, combined with PCA. These results achieved statistical significance with p = 0.0443. Total intravenous morphine equivalent use was similar between the three non-epidural groups. There was no difference in length of hospitalization or time until return of bowel function amongst the four groups.
Conclusions: Both epidural infusion and a three drug regimen of perioperative gabapentin, intraoperative dexmedetomidine, and PCA produced superior postoperative pain control compared with PCA alone or a combination of PCA and dexmedetomidine. The three drug regimen represents a preferred strategy as it provides optimal pain control without the theoretic risk of epidural hematoma in patients with a predictable postoperative coagulopathy. This pilot study serves as a template for future prospective examination of this three drug regimen versus epidural in major non-hepatic open abdominal surgery where post operative coagulopathy is less of a concern.