title: Prospective, randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors for liver transplantation.
abstract: Postoperative analgesia and care for living liver donors have become particular interests for clinicians as the use of living donor liver transplantation has increased. Local anesthetic-based analgesia has been known to provide effective pain control. In this prospective, randomized study, we compared the postoperative analgesic efficacy of local anesthetic-based analgesia (PainBuster) with the efficacy of opioid-based analgesia [intrathecal morphine (ITM) with intravenous (IV) fentanyl] in liver donors. Forty adult donors were randomly allocated to 1 of 2 groups: an ITM/IV fentanyl group (n = 21) and a PainBuster group (n = 19). Donors in the PainBuster group received 0.5% ropivacaine via a multi-orifice catheter (ON-Q PainBuster) placed at the wound. Donors in the ITM/IV fentanyl group received ITM sulfate (400 μg) preoperatively and a continuous IV fentanyl infusion postoperatively. A visual analogue scale (VAS) at rest and with coughing and rescue IV fentanyl and meperidine consumption were assessed for 72 hours after the operation. Side effects, including sedation, dizziness, nausea, vomiting, pruritus, respiratory depression, wound seroma or hematoma, and the first time to flatus, were recorded. The VAS score at rest during the first 12 postoperative hours was significantly lower for the ITM/IV fentanyl group. At other times, the VAS scores were comparable between the groups. In the PainBuster group, rescue IV fentanyl and meperidine use was significantly reduced 24 to 48 hours and 48 to 72 hours after surgery in comparison with the first 24 postoperative hours. The time to first flatus was significantly reduced in the PainBuster group. There were no differences in side effects. In conclusion, analgesia was more satisfactory with ITM/IV fentanyl versus PainBuster during the first 12 hours after surgery, but they became comparable thereafter, with a shortened bowel recovery time in the PainBuster group. The concurrent use of ITM with PainBuster may be considered in a future investigation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung City, Republic of Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Gwak
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Choi
authors.forename: Hui Gyeong
authors.initials: HG
authors.lastname: Park
authors.forename: Gaab Soo
authors.initials: GS
authors.lastname: Kim
authors.forename: Myung Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Ahn
authors.forename: Jieae
authors.initials: J
authors.lastname: Kim
authors.forename: Choon Hyuck
authors.initials: CH
authors.lastname: Kwon
authors.forename: Tae Seok
authors.initials: TS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods*; D007278:Injections, Spinal / Q000379:methods*; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000577:Amides; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D005283:Fentanyl