118.7: Pain management in living donor hepatectomy.

Abstract

Introduction: Organ donation from living family members still composes the majority of organ source in our country. Living donor hepatectomy (LDH) is often associated with significant acute and chronic postoperative pain and postoperative outcomes are effected by pain perception. Our postoperative analgesia regimen includes a thoracic epidural (bupivacaine 0.125%, fentanyl 0.1 mg/mL; 4 mL/h, bolus 5 mL, lockout 30 min) or intravenous (morphine, bolus 0.1mg/kg, lockout 10 min,) patient-controlled infusion. Two anaesthesiologists are dedicated to the Acute Pain Service and have the postoperative patients visited 4 times a day. Pain intensity is evaluated daily with an 11-point-numeric-scale (0–10) and prospectively registered in an electronic database. In case of ineffective epidural analgesia despite an additional bolus of local anaesthetic, the technique is changed to intravenous patient-controlled morphine infusion. We aimed to investigate our clinics pain management protocols effectiveness in LDH patients. Methods: We retrospectively investigated our pain management records from 2014 to 2019. Mode of analgesia technique, pain intensity, complications and side effects are recorded. Results: A total of 20 patients were (women n:6, men n:14) analysed. The mean age was 27,5 years (IQR: 22,75-37). Patients were followed for 2-3 days postoperatively for acute pain management and values obtained for the first two days are evaluated (Figure 1). Dural puncture happened in two patients but headache did not develop in both. Patients with intravenous patient controlled analgesia (n:3) had severe nausea (n:1) and constipation (n:1). None of the patients had hypotension or bradycardia in the postoperative period. Pain scores were higher in IV-PCA group. Conclusions: The donors are healthy adults who must be taken care of intensely. As stated in ERAS (enhanced recovery after surgery) protocols high epidural catheter placement is an effective mode of acute postoperative analgesia technique in LDH.