title: The relationship between postoperative intravenous patient-controlled fentanyl analgesic requirements and severity of liver disease.
abstract: OBJECTIVE
  Decreased inhalational anesthetic requirements during orthotopic liver transplantation (OLT) have been reported according to the severity of the pre-existent disease as well as decreased opioid requirements thereafter. The aim of the present study was to determine the relationship between postoperative opioid requirements and severity of liver disease among OLT patients.
  
  
  METHODS
  We retrospectively reviewed 44 recipients who used intravenous fentanyl-based patient-controlled analgesia (PCA) after OLT from November 2009 to May 2010. The severity of liver disease was assessed using the model for end-stage liver disease (MELD) score. Recipients were divided into a low-MELD group (<20; n=30) and a high-MELD group (≥20; n=14). The amounts of PCA infusion and rescue opioid up to 3 postoperative days (POD) were compared between the 2 groups. The intensity of pain at rest and when coughing was assessed using visual analog scale (VAS) scores.
  
  
  RESULTS
  The cumulative opioid requirements via PCA on POD 1, 2, and 3 were significantly lower in the high-MELD than the low-MELD group. The amounts of rescue opioid were similar between the 2 groups. However, the intensity of pain at both rest and when coughing on POD 1, 2, and 3 were significantly less severe in the high-MELD than the low-MELD group.
  
  
  CONCLUSIONS
  OLT patients with high MELD scores required less postoperative opioids and experienced less pain than those with low scores. Therefore, postoperative pain control after OLT should be carefully titrated according to the severity of the liver disease.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Ko
authors.forename: Y H
authors.initials: YH
authors.lastname: Shin
authors.forename: M S
authors.initials: MS
authors.lastname: Gwak
authors.forename: C H
authors.initials: CH
authors.lastname: Jang
authors.forename: G S
authors.initials: GS
authors.lastname: Kim
authors.forename: S-K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003371:Cough / Q000150:complications; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006305:Health Status Indicators; D006801:Humans; D007262:Infusions, Intravenous; D008107:Liver Diseases / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl