title: Continuous Paravertebral Infusions as an Effective Adjunct for Postoperative Pain Management in Living Liver Donors: A Retrospective Observational Study.
abstract: We analyzed the effectiveness of paravertebral-block for immediate postoperative pain control in living liver donors. Specifically, we sought to determine whether or not the addition of paravertebral catheters with continuous ropivacaine infusion would decrease postoperative opioid use and reduce the incidence of adverse effects and complications. We reviewed the records of 26 patients who underwent right-lobe living donor hepatectomy (RLDH): 16 with and 10 without such catheters. The primary outcome was opioid use on postoperative day (POD) 1 through 3. For each of those 3 days, we calculated each patient's opioid use in morphine equivalents (mg). We also noted pain scores, adverse effects, and complications. The rate of decrease in morphine equivalents was higher in the catheter group (rate of change = -22.72; P = .038) for POD 1 (0-24 hours) and POD 2 (25-48 hours) than in the noncatheter group. For POD 2 alone, the catheter group used, on average, 20.98 mg fewer morphine equivalents than the noncatheter group (P = .023). The catheter group had a markedly reduced pain trajectory postoperatively (P = .014) than the noncatheter group. The catheter placement procedure itself was safe.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mistry
authors.affiliation: Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hutchins
authors.affiliation: Division of Transplantation, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors.forename: J
authors.initials: J
authors.lastname: Leiting
authors.affiliation: Division of Transplantation, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mangalick
authors.affiliation: Division of Transplantation, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors.forename: T
authors.initials: T
authors.lastname: Pruett
authors.affiliation: Division of Transplantation, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA. Electronic address: chinni@umn.edu.
authors.forename: S
authors.initials: S
authors.lastname: Chinnakotla
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D060186:Infusions, Spinal; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D000077212:Ropivacaine; D060053:Transplant Donor Site / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine