You Want a Piece of Me? Evaluating Living Liver Donor Pain Management Outcomes After Donation

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: While multimodal analgesia and Enhanced Recovery After Surgery (ERAS) protocols have shown to effectively control pain while promoting early recovery in living liver donors undergoing hepatectomy, there is a paucity of data on sustained pain control beyond index discharge. Our review aims to evaluate the strategies utilized to ensure effective and sustained postoperative pain management in living liver donors for up to 12 months after surgery. Methods: This is a single center retrospective cross-sectional analysis evaluating post-operative pain management in adults who underwent elective hepatectomy between 2016-2023. The protocol includes pre and post- hepatectomy pain management counseling by PharmD, and use of a multimodal pain regimen including muscle relaxers, local analgesics, NSAIDs, and regional anesthesia along with opioids. The primary outcome was opioid requirements in Morphine Milligram Equivalents (MME) during inpatient stay, at discharge, 1-month, 6 weeks, 6 months and 12 months post hepatectomy. Secondary outcomes evaluated length of stay, multimodal pain regimen during inpatient stay and at discharge, average pain scores per each post-operative day while admitted, opioid-related adverse events, and re-admissions. Results: There were 55 patients included (30 females and 25 males, median age 37) with baseline characteristics as shown in Table 1. The majority of donors were opioid naive. All patients received multi-modal pain regimens post-hepatectomy, most commonly including regional anesthesia (76%) and intramuscular ketorolac (95%). The average pain score was 3.5 during an average 5-day stay. Only one patient required a pain management consult post-op. At 1-month post-hepatectomy, 85% of patients did not require new or additional pain medication and 91% did not require new or additional opioids. Pain requirements continued to decrease with time and minimal analgesic prescriptions were needed at 6 weeks and 6 months after donation (7% and 4%, respectively). At 1-year post-hepatectomy, analgesic prescriptions were not utilized by any of the donors. Conclusions: Few patients required pain-related medical visits and additional pain medication prescriptions post-hepatectomy. Pain control was adequately achieved with a multi-modal pain regimen during index admission which allowed for minimal opioid use outpatient and pain related re-admissions. Additionally, all patients received PharmD education pre-op and at time of discharge on prescribed pain medications and bowel regimen, which may have contributed to low incidence of opioid related adverse events. [Formula presented] CITATION INFORMATION: Stratton P., Jakupovic L., Fitzmaurice M., Poparad-Stezar A. You Want a Piece of Me? Evaluating Living Liver Donor Pain Management Outcomes After Donation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Poparad-Stezar: None.

Volume

25

Issue

8

First Page

S731

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