Transplantation Technologies & Research

ISSN: 2161-0991

Open Access

Adult Live Donor Hepatectomy: A Retrospective Pilot Study Comparing Four Strategies of Perioperative Pain Control


David M. Rosenfeld, Terrence L. Trentman, Daniel V. Simula, Michael G. Ivancic, Karl A. Poterack, Kent P. Weinmeister, David P.Seamans, David C. Mulligan and Brie N. Noble

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.


Share this article

50+ Million Readerbase

Recommended Conferences

International Conference and Expo on Heart and Cardio Care

Amsterdam, Netherlands

Journal Highlights

Google Scholar citation report
Citations: 184

Transplantation Technologies & Research received 184 citations as per Google Scholar report

Transplantation Technologies & Research peer review process verified at publons

Indexed In

Recommended Conferences
arrow_upward arrow_upward