Post-operative Pain Management of Orthotopic Liver Transplantation: Retrospective Study Qutaiba A Tawfic, Hussein Sadkhan*, Shaqayeq Marashi, Stephen Morrison, Kamal Kumar, Kevin Armstrong, Karim Qumosani and Achal Dhir Department of Anesthesia, Anesthesia and Perioperaative Medicine Hospital, London, Canada *Corresponding author: Dr Hussein Sadkhan, Department of Anesthesia, Anesthesia and Perioperaative Medicine University Hospital, London, Canada; E-mail: hussein.sadkhan@lhsc.on.ca Received date: December 25, 2019; Accepted date: January 08, 2020; Published date: January 14, 2020 Copyright: © 2020 Tawfic QA. 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. Abstract Introduction: Orthotopic liver transplantation (OLT) is one of the most extensive of all abdominal surgeries. The main focus of perioperative management for these patients has been to reduce mortality and morbidity, with little attention to postoperative pain management. This has resulted in a paucity of data on pain and its management in OLT. Method: This is a descriptive, retrospective study of OLT recipients at the London Health Sciences Centre, Western University, over five years (January 2011-December 2016). In addition to demographic information, we collected data regarding pain management modalities, specific opioid analgesics, route of administration and opioid- related serious side effects. Results: Data for 200 patients were included in this analysis. The mean visual analogue scores were: day one: 3.40 ± 1.71, day two: 4.99 ± 0.11 and day three: 4.75 ± 0.12. During their stay in the intensive care unit (ICU), 178 patients received intermittent boluses of an opioid (89%), nine patients received a continuous infusion of opioid (4.5%) and 13 patients received patient-controlled analgesia (PCA) (6.5%). There was no significant difference in mean pain scores between the three groups on day 1 (P=0.234). There was no respiratory depression/arrest observed related to opioid usage. Discussion: This study demonstrates that OLT patients experience moderate pain during the first three days following extubation. The data obtained from this investigation will help to formulate a better understanding of post OLT pain and optimize a pain management protocol that is both efficient and effective. Keywords: Orthotopic liver transplantation; Abdominal surgeries; Patient-controlled analgesia Introduction Orthotopic Liver transplant (OLT) in the most efective treatment for patients sufering from chronic and acute liver disease [1-3]. Compared to other major abdominal surgeries, OLT is one of the most extensive procedures in terms of duration, the complexity of the surgery and the surgical stress [1,3]. However, in recent years, better recipient selection, improvement in surgical techniques and advances in anesthesia and perioperative care have signifcantly decreased the perioperative morbidity and mortality in this patient population [3-5]. Adequate pain control is an important factor in patient recovery and satisfaction in the immediate postoperative period with shorter hospital stays and improved patient survival [3,4]. Pharmacodynamics and pharmacokinetics of many pain medications are altered in this population due to the change in drug distribution, metabolism and elimination. Tese factors may predispose post OLT patients to over- sedation and unnecessary prolonged mechanical ventilation [6-9]. Additionally, early extubation and fast-tracking afer OLT is gaining popularity [11]. Adequate analgesia is an important aspect of postoperative care; however, it is a clinical challenge to the team involved in the preoperative management of these patients [12]. Tere is a paucity of information on pain management afer OLT. Terefore, we conducted a retrospective study to evaluate the pain experience and its management for liver transplant recipients at our centre. Patients and Methods Afer receiving institutional research ethics board approval, we conducted a descriptive, retrospective study on OLT recipients at our centre (London Health Science Centre, Western University, London, Ontario, Canada). Te study period was fve years, from January 2011 to December 2016. All adult patients undergoing OLT with no history of preoperative chronic pain and were extubated within 48 hours afer the surgery were included in the study. Te exclusion criteria included postoperative intubation for more than 48 hours, more than one organ transplant, return to the operating room for a second-look surgery, graf failure and subsequent death, history of chronic pain, inability to assess pain scores and incomplete charting. Data were obtained from the hospital’s Electronic Medical records (EMR) and patients’ charts. Te data included patients’ demographics, preoperative pain scores, length of hospital stay and pain scores. Pain scores were recorded afer extubation and during their stay in the ICU and Multi-Organ Transplant Unit (MOTU). Additionally, data regarding pain management modalities, type and doses of opioid analgesics, route of administration and opioid-related side efects were collected. Descriptive statistical analysis (mean and standard deviation) and analysis of variance were used to analyze the data. J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research Tawfic et al., J Anesth Clin Res 2020, 11:1 Research Article Open Access J Anesth Clin Res, an open access journal ISSN: 2155-6148 Volume 11 • Issue 1 • 1000933