Effects of Pre-Existing Liver Disease on Acute Pain Management Using Patient-Controlled Analgesia Fentanyl With Parecoxib After Major Liver Resection: A Retrospective, Pragmatic Study

Abstract Background The aim of this study was to compare the outcomes of pain management with the use of patient-controlled analgesia (PCA) fentanyl with IV parecoxib between patients with healthy liver with patients with diseased liver undergoing major liver resection. Methods Patients with healthy...

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Bibliographic Details
Published in:Transplantation proceedings 2016-05, Vol.48 (4), p.1080-1082
Main Authors: Lim, K.I, Chiu, Y.C, Chen, C.L, Wang, C.H, Huang, C.J, Cheng, K.W, Wu, S.C, Shih, T.H, Yang, S.C, Juang, S.E, Huang, C.E, Jawan, B, Lee, Y.E
Format: Article
Language:English
Subjects:
Acute Pain - diagnosis
Acute Pain - drug therapy
Acute Pain - etiology
Adult
Aged
Analgesia, Patient-Controlled
Analgesics - therapeutic use
Drug Therapy, Combination
Female
Fentanyl - therapeutic use
Hepatectomy - adverse effects
Humans
Isoxazoles - therapeutic use
Liver Cirrhosis - surgery
Liver Transplantation
Living Donors
Male
Middle Aged
Pain Management
Pain Measurement
Pain, Postoperative - diagnosis
Pain, Postoperative - drug therapy
Pain, Postoperative - etiology
Retrospective Studies
Surgery
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Summary:Abstract Background The aim of this study was to compare the outcomes of pain management with the use of patient-controlled analgesia (PCA) fentanyl with IV parecoxib between patients with healthy liver with patients with diseased liver undergoing major liver resection. Methods Patients with healthy liver undergoing partial hepatectomy as liver donors for liver transplantation (group 1) and patients with liver cirrhosis (Child's criteria A) undergoing major liver resection for hepatoma (group 2) were identified retrospectively. Both groups routinely received post-operative IV PCA fentanyl and a single dose of parecoxib 40 mg. They were followed up for 3 days or until PCA fentanyl was discontinued post-operatively. Daily Visual Analog Scale, PCA fentanyl usage, rescue attempts, and common drug side effects were collected and analyzed with the use of SPSS version 20. Results One hundred one patients were included in the study: 54 in group 1, and 47 in group 2. There were no statistical differences between the two groups in terms of the daily and total fentanyl usage, VAS resting, and incidence of itchiness. The rate of rescue analgesia on post-operative day (POD) 1 was lower in group 2, with a value of P  = .045. VAS dynamics were better on POD 1 and 2 for group 2, with P  = .05 and P  = .012, respectively. Conclusions We found that combining a single dose of IV parecoxib 40 mg with PCA fentanyl is an easy and effective method of acute pain control after major liver resection. We propose the careful usage of post-operative fentanyl and parecoxib in patients with diseased liver, given the difference in effect as compared with healthy liver.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2015.11.023